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General NPI Number Information
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NPI Number | 1477830891
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Entity Type | Individual
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Provider Name | DEBRA K JANSEN RPH
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Gender | Female
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 18275 KENRICK AVE
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City | LAKEVILLE
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State | MN
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Zip | 55044-7306
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Country | US
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Telephone | 952-892-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 13540 GUILD AVE
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City | APPLE VALLEY
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State | MN
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Zip | 55124-7603
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Country | US
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Telephone | 952-432-3245
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Fax | 952-432-3245
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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 | 112121
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License Number State | MN
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