Provider Demographics
NPI:1720462377
Name:FREDERIKSEN, JESSICA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:FREDERIKSEN
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 1:145 N MILES ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56208-1316
Mailing Address - Country:US
Mailing Address - Phone:320-289-1252
Mailing Address - Fax:320-289-2691
Practice Address - Street 1:145 N MILES ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:MN
Practice Address - Zip Code:56208-1316
Practice Address - Country:US
Practice Address - Phone:320-289-1252
Practice Address - Fax:320-289-2691
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118101183500000X
SD5320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist