Healthcare Provider Details

I. General information

NPI: 1598352999
Provider Name (Legal Business Name): JENNIFER ELISE LODAHL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 HYLAND GREENS DR
BLOOMINGTON MN
55437-3934
US

IV. Provider business mailing address

1952 WELLESLEY AVE
SAINT PAUL MN
55105-1618
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-2400
  • Fax:
Mailing address:
  • Phone: 651-214-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number116907
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: