Provider Demographics
NPI:1366949331
Name:PFANNES, JANE MARIE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:PFANNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 STORY ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-3533
Mailing Address - Country:US
Mailing Address - Phone:515-432-2311
Mailing Address - Fax:515-432-8562
Practice Address - Street 1:403 STORY ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-3533
Practice Address - Country:US
Practice Address - Phone:515-432-2311
Practice Address - Fax:515-432-8562
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP16075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist