Provider Demographics
NPI:1437399177
Name:HALSTEN, JORDANNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDANNA
Middle Name:
Last Name:HALSTEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JORDANNA
Other - Middle Name:
Other - Last Name:CHAMBLISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2545 CHICAGO AVE S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-863-4190
Mailing Address - Fax:612-863-5702
Practice Address - Street 1:2545 CHICAGO AVE S
Practice Address - Street 2:SUITE 120
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-863-4190
Practice Address - Fax:612-863-5702
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist