Provider Demographics
NPI:1194011742
Name:JAHN, BARBARA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JAHN
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 1:1902 MILLER TRUNK HWY
Mailing Address - Street 2:T-0004
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1810
Mailing Address - Country:US
Mailing Address - Phone:218-727-8475
Mailing Address - Fax:218-727-8475
Practice Address - Street 1:1902 MILLER TRUNK HWY
Practice Address - Street 2:T-0004
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1810
Practice Address - Country:US
Practice Address - Phone:218-727-8475
Practice Address - Fax:218-727-8475
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist