Provider Demographics
NPI:1225278674
Name:LINDE, JESSICA ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:LINDE
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 1:927 TRETTEL LANE
Mailing Address - Street 2:FOND DU LAC HUMAN SERVICES DIVISION
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720
Mailing Address - Country:US
Mailing Address - Phone:218-878-2185
Mailing Address - Fax:218-878-3755
Practice Address - Street 1:927 TRETTEL LANE
Practice Address - Street 2:FOND DU LAC HUMAN SERVICES DIVISION
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720
Practice Address - Country:US
Practice Address - Phone:218-878-2185
Practice Address - Fax:218-878-3755
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist