Provider Demographics
NPI:1134253750
Name:DEWEY, MARK WILLIAM (PHARMD, CGP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:DEWEY
Suffix:
Gender:M
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23050 BIRCHWOOD ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-4518
Mailing Address - Country:US
Mailing Address - Phone:218-736-8057
Mailing Address - Fax:218-736-8787
Practice Address - Street 1:712 S CASCADE ST
Practice Address - Street 2:LAKE REGION HEALTHCARE CORP
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2913
Practice Address - Country:US
Practice Address - Phone:218-736-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116779-31835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric