Provider Demographics
NPI:1295011153
Name:STEPHEN, JILL ANN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2152
Mailing Address - Country:US
Mailing Address - Phone:320-654-8542
Mailing Address - Fax:320-654-8603
Practice Address - Street 1:1100 2ND ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2152
Practice Address - Country:US
Practice Address - Phone:320-654-8542
Practice Address - Fax:320-654-8603
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist