Healthcare Provider Details

I. General information

NPI: 1235392721
Provider Name (Legal Business Name): JENNIFER ELLEN EICKSTAEDT PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ELLEN OESTREICH

II. Dates (important events)

Enumeration Date: 07/06/2008
Last Update Date: 07/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2021
  • Fax:
Mailing address:
  • Phone: 507-284-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number119323
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14913-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: