Provider Demographics
NPI:1952522336
Name:ABRAHAMSON, EARL EDWARD
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:EDWARD
Last Name:ABRAHAMSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4740
Mailing Address - Country:US
Mailing Address - Phone:701-225-1086
Mailing Address - Fax:
Practice Address - Street 1:446 18TH ST W # 2
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3022
Practice Address - Country:US
Practice Address - Phone:701-225-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist