Provider Demographics
NPI:1184627804
Name:JACKMAN, JULIE ANN (PHARMD, BC-ACP, BCPP)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:PHARMD, BC-ACP, BCPP
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:GAMBAIANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD BCACP,BCPP
Mailing Address - Street 1:12595 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434
Mailing Address - Country:US
Mailing Address - Phone:612-219-4547
Mailing Address - Fax:651-243-6284
Practice Address - Street 1:9850 51ST AVE N STE 102
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-3271
Practice Address - Country:US
Practice Address - Phone:763-251-6920
Practice Address - Fax:763-251-6928
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116805-1183500000X
MN41506211835P1300X
MN61101231835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
4150621OtherBOARD OF PHARMACY SPECIALTIES- BCPP
6110123OtherBOARD OF PHARMACY SPECIALTIES- BCACP