Individual
JATESSA JATE LINN MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2029 5TH AVE S, FORT DODGE, IA 50501-4307
(515) 955-6453
Mailing address
1352 N 14TH ST, FORT DODGE, IA 50501-7532
(712) 369-0015
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
22862
IA
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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