Healthcare Provider Details

I. General information

NPI: 1174567119
Provider Name (Legal Business Name): KELLY JENNIFER SCHWEIM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E NICOLLET BLVD STE 200
BURNSVILLE MN
55337-4834
US

IV. Provider business mailing address

303 E NICOLLET BLVD
BURNSVILLE MN
55337-4522
US

V. Phone/Fax

Practice location:
  • Phone: 952-460-4099
  • Fax:
Mailing address:
  • Phone: 952-460-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118255-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: