Provider Demographics
NPI:1225350333
Name:BISHOP, JEFFREY R (PHARMD, BCPP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 WAYZATA BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1275
Mailing Address - Country:US
Mailing Address - Phone:612-273-8710
Mailing Address - Fax:612-273-8727
Practice Address - Street 1:5775 WAYZATA BLVD STE 255
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1275
Practice Address - Country:US
Practice Address - Phone:612-273-8710
Practice Address - Fax:612-273-8727
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1222151835P1300X
IA198731835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric