Provider Demographics
NPI:1396863189
Name:MENNEN, JAMES J (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:J
Last Name:MENNEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GOLDFINCH CIR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-4120
Mailing Address - Country:US
Mailing Address - Phone:319-338-2571
Mailing Address - Fax:319-337-6286
Practice Address - Street 1:812 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-5208
Practice Address - Country:US
Practice Address - Phone:319-337-4279
Practice Address - Fax:319-337-6286
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist