MEDICARE: JACQUELINE NESLUND PHARMACIST

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
1	1835P1200X	Pharmacotherapy Pharmacist	5315145501	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5315145501	OTHER	MI	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1598388613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE NESLUND PHARMACIST

Provider Business Mailing Address
First Line	:	20173 US 23 S
Second Line	:
City	:	PRESQUE ISLE
State	:	MI
Zip	:	49777-9061
Country	:	US
Telephone Number	:	989-464-2448
Fax Number	:

Provider Business Practice Location Address
First Line	:	20173 US 23 S
Second Line	:
City	:	PRESQUE ISLE
State	:	MI
Zip	:	49777-9061
Country	:	US
Telephone Number	:	989-278-8464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	04/25/2023

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