Healthcare Provider Details

I. General information

NPI: 1962449843
Provider Name (Legal Business Name): JAYCEE RAE REISENAUER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 7TH ST
BISMARCK ND
58501-4439
US

IV. Provider business mailing address

808 W INTERSTATE AVE
BISMARCK ND
58503-0908
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6186
  • Fax:
Mailing address:
  • Phone: 701-258-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5018
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number5018
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5018
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: