Individual
MRS. JACQUELIN RAE NUSSBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
12753 UNIVERSITY AVE, CLIVE, IA 50325-8246
(515) 226-1786
Mailing address
12753 UNIVERSITY AVE, CLIVE, IA 50325-8246
(515) 226-1786
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17861
IA
Other
Enumeration date
10/10/2011
Last updated
10/10/2011
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