Provider Demographics
NPI:1730493230
Name:FELDMAN, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 CHATBURN AVE
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-1845
Mailing Address - Country:US
Mailing Address - Phone:712-755-1112
Mailing Address - Fax:712-755-1369
Practice Address - Street 1:2099 CHATBURN AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-1845
Practice Address - Country:US
Practice Address - Phone:712-755-1112
Practice Address - Fax:712-755-1369
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist