Provider Demographics
NPI:1609484070
Name:AXELSSON, JODI LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:AXELSSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1982 OLD MISSION DR
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2304
Mailing Address - Country:US
Mailing Address - Phone:805-691-6139
Mailing Address - Fax:805-728-1191
Practice Address - Street 1:1982 OLD MISSION DR
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2304
Practice Address - Country:US
Practice Address - Phone:805-691-6139
Practice Address - Fax:805-728-1191
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist