Provider Demographics
NPI:1063718773
Name:THEIGE, JEFFREY LYNN (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LYNN
Last Name:THEIGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 S COLUMBIA RD STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4054
Mailing Address - Country:US
Mailing Address - Phone:701-746-1800
Mailing Address - Fax:701-746-4040
Practice Address - Street 1:1395 S COLUMBIA RD STE C
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4054
Practice Address - Country:US
Practice Address - Phone:701-746-1800
Practice Address - Fax:701-746-4040
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3678183500000X
MN113894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist