Provider Demographics
NPI:1174070908
Name:TRAISER, ALLISON RUDY (PHARMD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RUDY
Last Name:TRAISER
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 1:1304 E BOULEVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4234
Mailing Address - Country:US
Mailing Address - Phone:701-224-0175
Mailing Address - Fax:
Practice Address - Street 1:1304 E BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4234
Practice Address - Country:US
Practice Address - Phone:701-224-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist