Provider Demographics
NPI:1578127759
Name:HOUSEHOLTER, EMILY ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:HOUSEHOLTER
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 1:1655 98TH ST APT 105
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5043
Mailing Address - Country:US
Mailing Address - Phone:630-649-0728
Mailing Address - Fax:
Practice Address - Street 1:4415 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2717
Practice Address - Country:US
Practice Address - Phone:515-279-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist