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General NPI Number Information
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NPI Number | 1053353284
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Entity Type | Individual
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Provider Name | JEREMY JAMES EHLERT RPH, PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2310 HIGHWAY 29 S C/O KMART PHARMACY
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City | ALEXANDRIA
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State | MN
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Zip | 56308-3402
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Country | US
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Telephone | 320-763-7433
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Fax | 320-762-3943
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Provider Business Mailing Address
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Address Line | 4125 RUE DE FRENCHMAN NE
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2585
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Country | US
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Telephone | 320-763-4981
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Fax | 320-762-3943
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 116651-6
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License Number State | MN
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