Provider Demographics
NPI:1578858775
Name:MCDONNELL, JENNIFER (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19425 EVANS ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330
Mailing Address - Country:US
Mailing Address - Phone:763-441-0804
Mailing Address - Fax:763-323-8402
Practice Address - Street 1:3300 124TH AVE NW
Practice Address - Street 2:T2025
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3805
Practice Address - Country:US
Practice Address - Phone:763-323-8402
Practice Address - Fax:763-323-8402
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist