Provider Demographics
NPI:1588217715
Name:HALVORSEN, JADE LEIGH (PHARMD)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:LEIGH
Last Name:HALVORSEN
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 1:23148 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-8421
Mailing Address - Country:US
Mailing Address - Phone:641-437-7185
Mailing Address - Fax:641-856-0505
Practice Address - Street 1:23148 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-8421
Practice Address - Country:US
Practice Address - Phone:641-437-7185
Practice Address - Fax:641-856-0505
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist