Healthcare Provider Details

I. General information

NPI: 1225278674
Provider Name (Legal Business Name): JESSICA ANNE LINDE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 TRETTEL LANE FOND DU LAC HUMAN SERVICES DIVISION
CLOQUET MN
55720
US

IV. Provider business mailing address

927 TRETTEL LANE FOND DU LAC HUMAN SERVICES DIVISION
CLOQUET MN
55720
US

V. Phone/Fax

Practice location:
  • Phone: 218-878-2185
  • Fax: 218-878-3755
Mailing address:
  • Phone: 218-878-2185
  • Fax: 218-878-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number119366
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: