Provider Demographics
NPI:1962569343
Name:JESKE, CHERRY (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHERRY
Middle Name:
Last Name:JESKE
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 1:15405 STATE HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:HANSKA
Mailing Address - State:MN
Mailing Address - Zip Code:56041-4375
Mailing Address - Country:US
Mailing Address - Phone:507-359-4140
Mailing Address - Fax:
Practice Address - Street 1:121 DREW AVE SE
Practice Address - Street 2:
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1841
Practice Address - Country:US
Practice Address - Phone:507-642-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111707-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist