Healthcare Provider Details

I. General information

NPI: 1679587240
Provider Name (Legal Business Name): JENNIFER SYDNEY LAMBERG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-6465
  • Fax: 320-255-6360
Mailing address:
  • Phone: 320-259-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number117568-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: