Healthcare Provider Details

I. General information

NPI: 1912206210
Provider Name (Legal Business Name): JENNIFER MITCHELL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 98TH ST
BLOOMINGTON MN
55420-4713
US

IV. Provider business mailing address

509 W 98TH ST
BLOOMINGTON MN
55420-4713
US

V. Phone/Fax

Practice location:
  • Phone: 952-884-7528
  • Fax:
Mailing address:
  • Phone: 952-884-7528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number120439
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: