Provider Demographics
NPI:1245316157
Name:FOCKEN, REBECCA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:FOCKEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ALBRECHT BLVD
Mailing Address - Street 2:NDSU, SUDRO HALL, 118L
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58105-5055
Mailing Address - Country:US
Mailing Address - Phone:701-231-7477
Mailing Address - Fax:
Practice Address - Street 1:1401 ALBRECHT BLVD
Practice Address - Street 2:NDSU, SUDRO HALL, 118L
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58105-5055
Practice Address - Country:US
Practice Address - Phone:701-231-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1180576183500000X
ND4984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist