Provider Demographics
NPI:1508486234
Name:SEREM, EVA JEPTOO (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:JEPTOO
Last Name:SEREM
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 1:6160 QUINWOOD LN N APT 6316
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1311
Mailing Address - Country:US
Mailing Address - Phone:612-237-6282
Mailing Address - Fax:
Practice Address - Street 1:3633 BUNKER LAKE BLVD NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-7402
Practice Address - Country:US
Practice Address - Phone:763-421-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist