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General NPI Number Information
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NPI Number | 1598352999
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Entity Type | Individual
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Provider Name | JENNIFER ELISE LODAHL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 5320 HYLAND GREENS DR
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City | BLOOMINGTON
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State | MN
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Zip | 55437-3934
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Country | US
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Telephone | 952-993-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1952 WELLESLEY AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-1618
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Country | US
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Telephone | 651-214-8666
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Fax |
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 116907
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License Number State | MN
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