Provider Demographics
NPI:1275880775
Name:PULLIS, JESSICA NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:PULLIS
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 1:724 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56244-9745
Mailing Address - Country:US
Mailing Address - Phone:320-760-4072
Mailing Address - Fax:
Practice Address - Street 1:1805 MINNESOTA AVE STE 2
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1779
Practice Address - Country:US
Practice Address - Phone:320-842-3221
Practice Address - Fax:320-842-5231
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist