Healthcare Provider Details

I. General information

NPI: 1477485639
Provider Name (Legal Business Name): JARED MANGELS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E UNIVERSITY AVE
DES MOINES IA
50316-2302
US

IV. Provider business mailing address

4617 FILLMORE CT
DAVENPORT IA
52806-3609
US

V. Phone/Fax

Practice location:
  • Phone: 515-263-5100
  • Fax:
Mailing address:
  • Phone: 563-723-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: