Provider Demographics
NPI:1831479898
Name:LIND, JESSICA (PHARM D)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LIND
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HAMMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1555 NORTHWAY DRIVE #200
Mailing Address - Street 2:CENTRACARE FAMILY HEALTH CENTER
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4913
Mailing Address - Country:US
Mailing Address - Phone:320-240-3157
Mailing Address - Fax:320-240-3143
Practice Address - Street 1:1555 NORTHWAY DRIVE #200
Practice Address - Street 2:CENTRACARE FAMILY HEALTH CENTER
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4913
Practice Address - Country:US
Practice Address - Phone:320-240-3157
Practice Address - Fax:320-240-3143
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1203881835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist