Provider Demographics
NPI:1326228040
Name:JORGENSON, MINDI JO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MINDI
Middle Name:JO
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MINDI
Other - Middle Name:JO
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:404 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1257
Mailing Address - Country:US
Mailing Address - Phone:641-628-6616
Mailing Address - Fax:641-621-2357
Practice Address - Street 1:404 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1257
Practice Address - Country:US
Practice Address - Phone:641-628-6616
Practice Address - Fax:641-621-2357
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist