Provider Demographics
NPI:1326418666
Name:FRAZIER, JONATHAN HOLLIS (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:HOLLIS
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N ANKENY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4002
Mailing Address - Country:US
Mailing Address - Phone:515-964-3952
Mailing Address - Fax:515-964-3657
Practice Address - Street 1:901 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4002
Practice Address - Country:US
Practice Address - Phone:515-964-3952
Practice Address - Fax:515-964-3657
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA002150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist