Healthcare Provider Details

I. General information

NPI: 1841663267
Provider Name (Legal Business Name): JAMIE MALSTROM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N 11TH ST
MONTEVIDEO MN
56265-1629
US

IV. Provider business mailing address

824 N 11TH ST
MONTEVIDEO MN
56265-1629
US

V. Phone/Fax

Practice location:
  • Phone: 320-321-8250
  • Fax: 320-321-8357
Mailing address:
  • Phone: 320-321-8250
  • Fax: 320-321-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118159
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: