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Individual

JAKE BLOMS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DOCTOR OF PHARMACY

Contact information

Practice address
1921 COBORN BLVD, SAINT CLOUD, MN 56301-2100
(320) 252-4222
Mailing address
8555 QUADAY AVE NE UNIT 303, OTSEGO, MN 55330-6588
(701) 263-5774

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
125717
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
125717
PHARMACY LICENSE
MN
Enumeration date
08/10/2022
Last updated
08/10/2022
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