Individual
JENNIFER ANN LIANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6800 BASS LAKE RD, CRYSTAL, MN 55428-3935
(763) 533-5804
Mailing address
6800 BASS LAKE RD, CRYSTAL, MN 55428-3935
(763) 533-5804
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
123448
MN
Other
Enumeration date
08/20/2020
Last updated
08/20/2020
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