Provider Demographics
NPI:1235883612
Name:FIELD, JENNA RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:RAE
Last Name:FIELD
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 1:607 WASHINGTON AVE N UNIT 711
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2469
Mailing Address - Country:US
Mailing Address - Phone:218-841-1411
Mailing Address - Fax:
Practice Address - Street 1:701 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2611
Practice Address - Country:US
Practice Address - Phone:612-302-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist