Provider Demographics
NPI:1689789133
Name:PHABMIXAY, JENNY K (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:K
Last Name:PHABMIXAY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:K
Other - Last Name:VANDERSCHOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1513 61ST ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-1913
Mailing Address - Country:US
Mailing Address - Phone:515-681-9114
Mailing Address - Fax:
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist