Provider Demographics
NPI:1790914455
Name:MOK, JEAN Y (PHARMD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:Y
Last Name:MOK
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 1:1 FEDERAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT SNELLING
Mailing Address - State:MN
Mailing Address - Zip Code:55111-4080
Mailing Address - Country:US
Mailing Address - Phone:612-467-7901
Mailing Address - Fax:
Practice Address - Street 1:1 FEDERAL DR
Practice Address - Street 2:
Practice Address - City:FORT SNELLING
Practice Address - State:MN
Practice Address - Zip Code:55111-4080
Practice Address - Country:US
Practice Address - Phone:612-467-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512930071835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy