Provider Demographics
NPI:1679089452
Name:DAINOVIEC, JAROD NATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAROD
Middle Name:NATHAN
Last Name:DAINOVIEC
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 1:1202 HILL ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2775
Mailing Address - Country:US
Mailing Address - Phone:231-590-3562
Mailing Address - Fax:
Practice Address - Street 1:1133 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9305
Practice Address - Country:US
Practice Address - Phone:231-348-2767
Practice Address - Fax:231-348-2767
Is Sole Proprietor?:No
Enumeration Date:2017-12-16
Last Update Date:2017-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist