Healthcare Provider Details

I. General information

NPI: 1649259680
Provider Name (Legal Business Name): JEREMY PAUL ANDERSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 4TH AVE SW
ROCHESTER MN
55905-0014
US

IV. Provider business mailing address

607 14TH AVE NW
KASSON MN
55944-1684
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-8880
  • Fax:
Mailing address:
  • Phone: 507-634-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117013-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: