Provider Demographics
NPI:1740689355
Name:JANKU, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JANKU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1605
Mailing Address - Country:US
Mailing Address - Phone:320-253-6601
Mailing Address - Fax:320-253-7858
Practice Address - Street 1:115 2ND AVE N
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1605
Practice Address - Country:US
Practice Address - Phone:320-253-6601
Practice Address - Fax:320-253-7858
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist