Provider Demographics
NPI:1679990857
Name:LITTLE, JODIE (PHARMD, CGP)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W. CENTRAL ENTRANCE
Mailing Address - Street 2:SHOPKO PHARMACY 2114
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-727-7139
Mailing Address - Fax:218-727-6240
Practice Address - Street 1:801 W. CENTRAL ENTRANCE
Practice Address - Street 2:SHOPKO PHARMACY 2114
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-727-7139
Practice Address - Fax:218-727-6240
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1160551835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric