Provider Demographics
NPI:1750425070
Name:NOLD, JEANIE ALYSON (RPH)
Entity type:Individual
Prefix:MS
First Name:JEANIE
Middle Name:ALYSON
Last Name:NOLD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JEANIE
Other - Middle Name:ALYSON
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1801 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-5490
Mailing Address - Country:US
Mailing Address - Phone:605-997-2122
Mailing Address - Fax:605-997-5408
Practice Address - Street 1:127 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028-1222
Practice Address - Country:US
Practice Address - Phone:605-997-2122
Practice Address - Fax:605-997-5408
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist