Individual
JACOB NIEMELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
1611 COUNTY ROAD C W, ROSEVILLE, MN 55113-1302
(651) 636-9369
(651) 636-4015
Mailing address
10635 WELCOME BAY N, BROOKLYN PARK, MN 55443-3268
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
118885
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
512560000
—
MN
Enumeration date
10/28/2011
Last updated
10/28/2011
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