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Individual

JENNIFER RAE LISSICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
(612) 813-7259
Mailing address
6462 151ST STREET CIR N, HUGO, MN 55038-8495
(651) 231-8114

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
120117
MN

Other

Enumeration date
08/31/2010
Last updated
08/31/2010
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