Individual
JACOB C NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
441 ARROWHEAD LN, MOOSE LAKE, MN 55767-7702
(218) 485-4401
(218) 485-8774
Mailing address
PO BOX 719, MOOSE LAKE, MN 55767-0719
(218) 485-4401
(218) 485-8774
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
120004
MN
Other
Enumeration date
07/09/2013
Last updated
07/09/2013
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