Provider Demographics
NPI:1912493503
Name:DEMARCE, VICTORIA JO (RPH)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JO
Last Name:DEMARCE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7593 NE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-1148
Mailing Address - Country:US
Mailing Address - Phone:515-210-8079
Mailing Address - Fax:
Practice Address - Street 1:404 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1730
Practice Address - Country:US
Practice Address - Phone:515-962-9399
Practice Address - Fax:515-962-2202
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist