Provider Demographics
NPI:1366165482
Name:THAO, JAMIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:THAO
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 1:5797 WASHINGTON ST NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5667
Mailing Address - Country:US
Mailing Address - Phone:651-274-5120
Mailing Address - Fax:
Practice Address - Street 1:4400 OAK GROVE PKWY N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-4001
Practice Address - Country:US
Practice Address - Phone:651-274-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist