MEDICARE: MRS. JANNA FINE KENIGSBERG PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	119144	MN

General Provider Information

NPI Number	:	1043496151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANNA FINE KENIGSBERG PHARM D

Provider Business Mailing Address
First Line	:	5035 GARLAND LN N APT C
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-2461
Country	:	US
Telephone Number	:	612-741-8425
Fax Number	:

Provider Business Practice Location Address
First Line	:	5035 GARLAND LN N APT C
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-2461
Country	:	US
Telephone Number	:	612-741-8425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2008
Last Update Date	:	01/18/2008

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