Healthcare Provider Details

I. General information

NPI: 1679990857
Provider Name (Legal Business Name): JODIE LITTLE PHARM.D., CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

801 W. CENTRAL ENTRANCE SHOPKO PHARMACY 2114
DULUTH MN
55811
US

IV. Provider business mailing address

801 W. CENTRAL ENTRANCE SHOPKO PHARMACY 2114
DULUTH MN
55811
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-7139
  • Fax: 218-727-6240
Mailing address:
  • Phone: 218-727-7139
  • Fax: 218-727-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number116055
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: