Individual provider · NPI-1

Jerome Borth, R.Ph.

Pharmacist · Mankato, MN

NPI number1609161504
StatusActive
Last updated in NPPESJun 20, 2011

Details

NPI
1609161504
Entity type
Individual (NPI-1)
Name
Jerome Borth
Credential
R.Ph.
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 20, 2011
Last updated
Jun 20, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
183500000X Pharmacist112215MNYes

Practice location

1850 Adams St
Target Store T0663
Mankato, MN 56001-4864

Phone 507-625-9009 · Fax 507-625-9009

Mailing address

1850 Adams St
Target Store T0663
Mankato, MN 56001-4864

Phone 507-625-9009 · Fax 507-625-9009

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