Provider Demographics
NPI:1659516771
Name:REHM, JACKIE R (RPH)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:R
Last Name:REHM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:101 E 4TH ST SEIP PRESCRIPTION SHOPPE
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470
Mailing Address - Country:US
Mailing Address - Phone:218-237-5848
Mailing Address - Fax:218-237-5849
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:SNYDER DRUG 5008
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470
Practice Address - Country:US
Practice Address - Phone:218-732-3342
Practice Address - Fax:218-732-5053
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2009-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN112723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist