Provider Demographics
NPI:1932796414
Name:MUNSON, JACQUELYN GLORIA (RPH)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:GLORIA
Last Name:MUNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3677 WHITE PINE WAY
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7052
Mailing Address - Country:US
Mailing Address - Phone:612-750-1520
Mailing Address - Fax:
Practice Address - Street 1:1801 MARKET DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7599
Practice Address - Country:US
Practice Address - Phone:651-430-2362
Practice Address - Fax:651-439-9376
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist