Provider Demographics
NPI:1043408289
Name:WINTER, JESSICA RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:WINTER
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 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1651
Mailing Address - Country:US
Mailing Address - Phone:507-825-3100
Mailing Address - Fax:507-825-5810
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1651
Practice Address - Country:US
Practice Address - Phone:507-825-3100
Practice Address - Fax:507-825-5810
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5504183500000X
MN118846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist