Provider Demographics
NPI:1194971705
Name:BLOEDOW, JESSICA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:BLOEDOW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 WESTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-2337
Mailing Address - Country:US
Mailing Address - Phone:507-354-0912
Mailing Address - Fax:507-354-0914
Practice Address - Street 1:1720 WESTRIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-2337
Practice Address - Country:US
Practice Address - Phone:507-354-0912
Practice Address - Fax:507-354-0914
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist