Provider Demographics
NPI:1023232097
Name:SHIELDS, JOEL DEAN (RPH)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:DEAN
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1033 HOWE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-9044
Mailing Address - Country:US
Mailing Address - Phone:641-792-8855
Mailing Address - Fax:641-792-8855
Practice Address - Street 1:1610 VERMEER RD E
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7658
Practice Address - Country:US
Practice Address - Phone:641-621-7470
Practice Address - Fax:641-621-7471
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA13515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist