Provider Demographics
NPI:1043356702
Name:GREISEN, JEANNE KATHERINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:KATHERINE
Last Name:GREISEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 156TH LN NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4562
Mailing Address - Country:US
Mailing Address - Phone:763-434-5570
Mailing Address - Fax:
Practice Address - Street 1:18185 ZANE ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4505
Practice Address - Country:US
Practice Address - Phone:763-441-5332
Practice Address - Fax:763-441-5591
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118447-5183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist