Provider Demographics
NPI:1609159458
Name:HASS, JILL ANN (BS)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANN
Last Name:HASS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:CHRISTIANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:7000 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3224
Mailing Address - Country:US
Mailing Address - Phone:515-276-4903
Mailing Address - Fax:
Practice Address - Street 1:7000 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3224
Practice Address - Country:US
Practice Address - Phone:515-276-4903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15472183500000X
SDR4200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist