Provider Demographics
NPI:1053353284
Name:EHLERT, JEREMY JAMES (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JAMES
Last Name:EHLERT
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 RUE DE FRENCHMAN NE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2585
Mailing Address - Country:US
Mailing Address - Phone:320-763-4981
Mailing Address - Fax:320-762-3943
Practice Address - Street 1:2310 HIGHWAY 29 S
Practice Address - Street 2:C/O KMART PHARMACY
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3402
Practice Address - Country:US
Practice Address - Phone:320-763-7433
Practice Address - Fax:320-762-3943
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116651-6183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist