Provider Demographics
NPI:1316358146
Name:CHRISTENSEN, JAIMI BREELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAIMI
Middle Name:BREELLE
Last Name:CHRISTENSEN
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:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-0887
Mailing Address - Country:US
Mailing Address - Phone:802-558-2676
Mailing Address - Fax:802-768-8195
Practice Address - Street 1:6 DEEP WOODS CIRCLE
Practice Address - Street 2:
Practice Address - City:WINHALL
Practice Address - State:VT
Practice Address - Zip Code:05340
Practice Address - Country:US
Practice Address - Phone:802-558-2676
Practice Address - Fax:802-768-8195
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0330003601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist