Provider Demographics
NPI:1235276965
Name:LEUSINK, JILL N (PHARMD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:N
Last Name:LEUSINK
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 1:724 19TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1605
Mailing Address - Country:US
Mailing Address - Phone:712-470-7577
Mailing Address - Fax:
Practice Address - Street 1:420 2ND AVE
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-1205
Practice Address - Country:US
Practice Address - Phone:712-754-3859
Practice Address - Fax:712-754-4271
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19917183500000X
MN117770-9183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist