Active NPI
Jennie Deziel
- Pharmacist
- West St Paul, MN
National Provider Identifier
1851687271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 114476
- Practice address
- 1750 Robert St S
T-2046
West St Paul, MN 55118-3919 - Phone
- (651) 455-6626
- Fax
- (651) 455-1903
- NPI assigned
- Jun 23, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 114476 | MN | Primary |
Addresses
Primary practice location
1750 Robert St S
T-2046
West St Paul, MN 55118-3919
Mailing address
1750 Robert St S
T-2046
West St Paul, MN 55118-3919
Phone (651) 455-6626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114476 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308787200000",
"number": "1851687271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 ROBERT ST S",
"address_2": "T-2046",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551183919",
"telephone_number": "651-455-6626",
"fax_number": "651-455-1903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 ROBERT ST S",
"address_2": "T-2046",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551183919",
"telephone_number": "651-455-6626",
"fax_number": "651-455-1903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEZIEL",
"first_name": "JENNIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-23",
"last_updated": "2011-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "114476",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West St Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.