Provider Demographics
NPI:1598641185
Name:STALBERGER, JESSICA (CPHT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STALBERGER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:STALBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACY TECHNICIAN
Mailing Address - Street 1:3726 XENIA AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1949
Mailing Address - Country:US
Mailing Address - Phone:626-946-9709
Mailing Address - Fax:
Practice Address - Street 1:3726 XENIA AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-1949
Practice Address - Country:US
Practice Address - Phone:626-946-9709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN731085183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty