Provider Demographics
NPI:1417398173
Name:MIDGARDEN, JENNA ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:ANNE
Last Name:MIDGARDEN
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 1:38 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2212
Mailing Address - Country:US
Mailing Address - Phone:701-325-0831
Mailing Address - Fax:
Practice Address - Street 1:38 E 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2212
Practice Address - Country:US
Practice Address - Phone:701-325-0831
Practice Address - Fax:701-352-1910
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist