Healthcare Provider Details

I. General information

NPI: 1447189436
Provider Name (Legal Business Name): JODI NORDSTROM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16752 73RD PL N
MAPLE GROVE MN
55311-2130
US

IV. Provider business mailing address

16752 73RD PL N
MAPLE GROVE MN
55311-2130
US

V. Phone/Fax

Practice location:
  • Phone: 626-644-1163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117743
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: