Individual
JEAN ANN THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
409 MAIN ST, MAPLETON, IA 50134-0069
(712) 881-1033
(712) 881-1206
Mailing address
211 S 5TH ST, MAPLETON, IA 51034-1203
(712) 881-1033
(712) 881-1203
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17193
IA
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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