Provider Demographics
NPI:1609271956
Name:VETTER, JAREK M (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAREK
Middle Name:M
Last Name:VETTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 SE 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-9753
Mailing Address - Country:US
Mailing Address - Phone:515-418-8064
Mailing Address - Fax:
Practice Address - Street 1:6720 SE 55TH ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-9753
Practice Address - Country:US
Practice Address - Phone:515-418-8064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist