Individual
JORDAN RIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
2000 PAUL BUNYAN DR NW, BEMIDJI, MN 56601-5603
(218) 751-6380
Mailing address
2000 PAUL BUNYAN DR NW, BEMIDJI, MN 56601-5603
(218) 751-6380
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PHA-PHA-LIC-35850
MT
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
123955
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123955
PHARMACIST LICENSE
MN
01
—
MT35850
PHARMACIST LICENSE
MT
Enumeration date
08/09/2017
Last updated
05/17/2021
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