Provider Demographics
NPI:1578188645
Name:JEROME, LAURA JEAN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:JEROME
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:CRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6850 MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2424
Mailing Address - Country:US
Mailing Address - Phone:309-221-9370
Mailing Address - Fax:
Practice Address - Street 1:2802 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4708
Practice Address - Country:US
Practice Address - Phone:641-753-3204
Practice Address - Fax:641-753-0057
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist