Provider Demographics
NPI:1275094245
Name:VASKE, JEANNINE C (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:C
Last Name:VASKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:C
Other - Last Name:FAVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3105 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4604
Mailing Address - Country:US
Mailing Address - Phone:515-233-1736
Mailing Address - Fax:
Practice Address - Street 1:3105 GRAND AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4604
Practice Address - Country:US
Practice Address - Phone:515-233-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-30
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist