Provider Demographics
NPI:1073730792
Name:JONSRUD, KATHRYN LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LYNN
Last Name:JONSRUD
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 1:16357 VICTORIA CURV SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-3371
Mailing Address - Country:US
Mailing Address - Phone:952-447-8117
Mailing Address - Fax:
Practice Address - Street 1:16357 VICTORIA CURV SE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-3371
Practice Address - Country:US
Practice Address - Phone:952-447-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist