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NPI Code Detail

MEDICARE: DR. STACEY JASSEY PHARMD

MEDICARE: DR. STACEY JASSEY PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835N1003XNutrition Support Pharmacist114588MN
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist114588MN

General Provider Information

NPI Number : 1528380326
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACEY JASSEY PHARMD
Provider Business Mailing Address
First Line : 711 KASOTA AVE SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-2842
Country : US
Telephone Number : 612-669-9437
Fax Number :
Provider Business Practice Location Address
First Line : 711 KASOTA AVE SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-2842
Country : US
Telephone Number : 612-669-9437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2010
Last Update Date : 10/08/2012

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