Provider Demographics
NPI:1114571478
Name:LUNDSGAARD, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LUNDSGAARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1209
Mailing Address - Country:US
Mailing Address - Phone:712-229-7911
Mailing Address - Fax:
Practice Address - Street 1:218 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-2044
Practice Address - Country:US
Practice Address - Phone:712-225-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist