Provider Demographics
NPI:1003183633
Name:PARK JANKOWSKI, JULI A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULI
Middle Name:A
Last Name:PARK JANKOWSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JULI
Other - Middle Name:A
Other - Last Name:KINZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1788 OLD HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4307
Mailing Address - Country:US
Mailing Address - Phone:651-731-9633
Mailing Address - Fax:651-731-9678
Practice Address - Street 1:1788 OLD HUDSON RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4307
Practice Address - Country:US
Practice Address - Phone:651-731-9633
Practice Address - Fax:651-731-9678
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4546183500000X
MN114936183500000X
MN1149368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist