Provider Demographics
NPI:1629268172
Name:TARABA, JODI LYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYN
Last Name:TARABA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:GRABINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MSC - 6220
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-567-8355
Mailing Address - Fax:210-567-8328
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-4404
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist