Provider Demographics
NPI:1467675538
Name:DENHERDER, RHIANNON LOUISE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:RHIANNON
Middle Name:LOUISE
Last Name:DENHERDER
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 1:2636 MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-6036
Mailing Address - Country:US
Mailing Address - Phone:641-485-7781
Mailing Address - Fax:
Practice Address - Street 1:7101 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50311-1436
Practice Address - Country:US
Practice Address - Phone:515-279-4408
Practice Address - Fax:515-279-9691
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0168484Medicaid
IA0168484Medicaid