Provider Demographics
NPI:1619270477
Name:GRASSMANN, JESSICA A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:GRASSMANN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 GRANT ST NW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-4831
Mailing Address - Country:US
Mailing Address - Phone:507-317-4888
Mailing Address - Fax:
Practice Address - Street 1:1920 GRANT ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4831
Practice Address - Country:US
Practice Address - Phone:507-317-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist