Provider Demographics
NPI:1558996116
Name:VAN MAANEN, RAELLE CHRISTINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAELLE
Middle Name:CHRISTINE
Last Name:VAN MAANEN
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 1:1951 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1173
Mailing Address - Country:US
Mailing Address - Phone:712-722-3516
Mailing Address - Fax:
Practice Address - Street 1:1951 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1173
Practice Address - Country:US
Practice Address - Phone:712-722-3516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist