Provider Demographics
NPI:1952687808
Name:NAGEL, KORI JO (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:KORI
Middle Name:JO
Last Name:NAGEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 86TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1026
Mailing Address - Country:US
Mailing Address - Phone:515-252-7355
Mailing Address - Fax:515-252-9916
Practice Address - Street 1:4600 86TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-1026
Practice Address - Country:US
Practice Address - Phone:515-252-7355
Practice Address - Fax:515-252-9916
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist