Individual
MRS. JACQUELINE CAROLE VANDER VELDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 N MICHIGAN ST, PLYMOUTH, IN 46563-1735
(574) 936-3167
Mailing address
17375 2B RD, WALKERTON, IN 46574-8620
(574) 586-3922
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2601475A
IN
Other
Enumeration date
08/15/2006
Last updated
07/08/2007
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