Individual
JENNIE DEZIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1750 ROBERT ST S, T-2046, WEST ST PAUL, MN 55118-3919
(651) 455-6626
(651) 455-1903
Mailing address
1750 ROBERT ST S, T-2046, WEST ST PAUL, MN 55118-3919
(651) 455-6626
(651) 455-1903
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
114476
MN
Other
Enumeration date
06/23/2011
Last updated
06/23/2011
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