Provider Demographics
NPI:1932523198
Name:STEPHAN, JASMINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:WIESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 GOEMANN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4226
Mailing Address - Country:US
Mailing Address - Phone:507-235-2517
Mailing Address - Fax:507-235-2519
Practice Address - Street 1:1250 GOEMANN RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4226
Practice Address - Country:US
Practice Address - Phone:507-235-2517
Practice Address - Fax:507-235-2519
Is Sole Proprietor?:No
Enumeration Date:2014-02-08
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN121299OtherPHARMACIST LICENSE