Provider Demographics
NPI:1336431469
Name:JENNISSEN, AARON B (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:B
Last Name:JENNISSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 SHERMAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55038-4614
Mailing Address - Country:US
Mailing Address - Phone:651-207-8519
Mailing Address - Fax:
Practice Address - Street 1:1435 SHERMAN LAKE RD
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55038-4614
Practice Address - Country:US
Practice Address - Phone:651-207-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist