Healthcare Provider Details

I. General information

NPI: 1003148784
Provider Name (Legal Business Name): JEFF PARLANTI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S POKEGAMA AVE
GRAND RAPIDS MN
55744-3905
US

IV. Provider business mailing address

1111 S POKEGAMA AVE
GRAND RAPIDS MN
55744-3905
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-0593
  • Fax:
Mailing address:
  • Phone: 218-326-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number112757
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: