Provider Demographics
NPI:1992398788
Name:ANDERSON, JENNA LYNN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:BERTHA
Mailing Address - State:MN
Mailing Address - Zip Code:56437-2002
Mailing Address - Country:US
Mailing Address - Phone:218-924-2124
Mailing Address - Fax:218-924-2129
Practice Address - Street 1:124 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:BERTHA
Practice Address - State:MN
Practice Address - Zip Code:56437-2002
Practice Address - Country:US
Practice Address - Phone:218-924-2124
Practice Address - Fax:218-924-2129
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist