MEDICARE: DR. JULIE ANN JACKMAN PHARMD, BC-ACP, BCPP

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	116805-1	MN
2	1835P1300X	Psychiatric Pharmacist	4150621	MN
3	1835P2201X	Ambulatory Care Pharmacist	6110123	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4150621	OTHER		BOARD OF PHARMACY SPECIALTIES- BCPP
2	6110123	OTHER		BOARD OF PHARMACY SPECIALTIES- BCACP

General Provider Information

NPI Number	:	1184627804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE ANN JACKMAN PHARMD, BC-ACP, BCPP

Provider Business Mailing Address
First Line	:	12595 CENTRAL AVE NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55434
Country	:	US
Telephone Number	:	612-219-4547
Fax Number	:	651-243-6284

Provider Business Practice Location Address
First Line	:	9850 51ST AVE N STE 102
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55442-3271
Country	:	US
Telephone Number	:	763-251-6920
Fax Number	:	763-251-6928

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/01/2024

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