Provider Demographics
NPI:1134384100
Name:FITZ, ALICIA LYNN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:LYNN
Last Name:FITZ
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 CENTENNIAL BLVD
Mailing Address - Street 2:NDSU STUDENT HEALTH CENTER PHARMACY
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58105-5313
Mailing Address - Country:US
Mailing Address - Phone:701-231-7332
Mailing Address - Fax:701-231-6132
Practice Address - Street 1:1707 CENTENNIAL BLVD
Practice Address - Street 2:NDSU STUDENT HEALTH CENTER PHARMACY
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58105-5313
Practice Address - Country:US
Practice Address - Phone:701-231-7332
Practice Address - Fax:701-231-6132
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5106183500000X
MN116310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist