Provider Demographics
NPI:1932263639
Name:DEMONG, JAMES HARLAND (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HARLAND
Last Name:DEMONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732
Mailing Address - Country:US
Mailing Address - Phone:563-243-3189
Mailing Address - Fax:
Practice Address - Street 1:629 6TH AVE
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:IA
Practice Address - Zip Code:52742
Practice Address - Country:US
Practice Address - Phone:563-659-5042
Practice Address - Fax:563-659-5044
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist