Provider Demographics
NPI:1649660499
Name:HJELM, JONATHAN BARRY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BARRY
Last Name:HJELM
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 1:2503 N HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2569
Mailing Address - Country:US
Mailing Address - Phone:715-852-2991
Mailing Address - Fax:
Practice Address - Street 1:800 WISCONSIN ST
Practice Address - Street 2:SUITE 18-101
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-3588
Practice Address - Country:US
Practice Address - Phone:715-852-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16936-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist