Provider Demographics
NPI:1932125473
Name:RAFFERTY, JANET (RPH)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:RAFFERTY
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 1:4836 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2087
Mailing Address - Country:US
Mailing Address - Phone:563-332-5622
Mailing Address - Fax:
Practice Address - Street 1:201 10TH AVE W
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-2342
Practice Address - Country:US
Practice Address - Phone:309-756-9907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16542183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist