Individual
DR. JULIE ANN JACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD, BC-ACP, BCPP
Contact information
Practice address
9850 51ST AVE N STE 102, PLYMOUTH, MN 55442-3271
(763) 251-6920
(763) 251-6928
Mailing address
12595 CENTRAL AVE NE, BLAINE, MN 55434
(612) 219-4547
(651) 243-6284
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
116805-1
MN
1835P1300X
Psychiatric Pharmacist
4150621
MN
1835P2201X
Ambulatory Care Pharmacist
Primary
6110123
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4150621
BOARD OF PHARMACY SPECIALTIES- BCPP
—
01
—
6110123
BOARD OF PHARMACY SPECIALTIES- BCACP
—
Enumeration date
05/27/2005
Last updated
02/01/2024
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