Provider Demographics
NPI:1164953741
Name:HENNEN, EMMA MARGARET JINDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MARGARET JINDRA
Last Name:HENNEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:MARGARET
Other - Last Name:JINDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:275 RAMPART WAY
Mailing Address - Street 2:APT 204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6463
Mailing Address - Country:US
Mailing Address - Phone:651-235-6464
Mailing Address - Fax:
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-7259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123077183500000X
COPHA.0020885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist