Provider Demographics
NPI:1558648220
Name:FJORDBAK, BARBARA LEE (RPH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LEE
Last Name:FJORDBAK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2606
Mailing Address - Country:US
Mailing Address - Phone:319-341-6153
Mailing Address - Fax:
Practice Address - Street 1:102 2ND ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2606
Practice Address - Country:US
Practice Address - Phone:319-341-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14750183500000X
TX23178183500000X
WY2664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist