Healthcare Provider Details

I. General information

NPI: 1396556353
Provider Name (Legal Business Name): JESSICA NORMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 LABORE RD
VADNAIS HEIGHTS MN
55110-5186
US

IV. Provider business mailing address

5636 LOGAN AVE S
MINNEAPOLIS MN
55419-1512
US

V. Phone/Fax

Practice location:
  • Phone: 651-363-5416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number122769
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: