Individual
CASEY JENNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
5094 151ST ST W, APPLE VALLEY, MN 55124-7043
(651) 247-8945
Mailing address
5094 151ST ST W, APPLE VALLEY, MN 55124-7043
(651) 247-8945
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
121783
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121783
MN BOARD OF PHARMACY LICENSE
MN
Enumeration date
09/26/2014
Last updated
11/16/2021
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