Provider Demographics
NPI:1578850723
Name:CISEWSKI LUOMA, JILL M (RPH)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:CISEWSKI LUOMA
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 1:30606 MARIGOLD LN
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-7301
Mailing Address - Country:US
Mailing Address - Phone:651-245-1242
Mailing Address - Fax:
Practice Address - Street 1:2021 MARKET DR
Practice Address - Street 2:T-0931
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7546
Practice Address - Country:US
Practice Address - Phone:651-439-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist