Healthcare Provider Details

I. General information

NPI: 1689580623
Provider Name (Legal Business Name): JESSICA ROTHSTEIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR STE 1600
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

920 CELEBRATION CIR
SARTELL MN
56377-4505
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number117208
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: