Healthcare Provider Details

I. General information

NPI: 1073773925
Provider Name (Legal Business Name): JENNY LYNN GAU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 GOLDEN VALLEY RD
GOLDEN VALLEY MN
55427-4409
US

IV. Provider business mailing address

8240 GOLDEN VALLEY RD
GOLDEN VALLEY MN
55427-4409
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-8300
  • Fax: 952-993-1334
Mailing address:
  • Phone: 952-993-8300
  • Fax: 952-993-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117521
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: