Provider Demographics
NPI:1962153247
Name:MACHTEMES, JAMIE LYNN
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:MACHTEMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 CEDAR TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:LE SUEUR
Mailing Address - State:MN
Mailing Address - Zip Code:56058-2450
Mailing Address - Country:US
Mailing Address - Phone:612-916-0810
Mailing Address - Fax:507-931-9028
Practice Address - Street 1:612 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2100
Practice Address - Country:US
Practice Address - Phone:507-931-5540
Practice Address - Fax:507-931-9028
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist