Healthcare Provider Details

I. General information

NPI: 1285911743
Provider Name (Legal Business Name): JACQUELINE MEWS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 01/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 BROOKLYN BLVD
BROOKLYN PARK MN
55443-2906
US

IV. Provider business mailing address

5227 BLACK FRIARS LN
MINNETONKA MN
55345-4002
US

V. Phone/Fax

Practice location:
  • Phone: 763-566-8350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2011027345
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1075271
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: