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General NPI Number Information
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NPI Number | 1205478922
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Entity Type | Individual
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Provider Name | VIRGINIA KAY FIENUP R. PH.
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Gender | Female
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 110 10TH ST SW
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City | WAVERLY
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State | IA
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Zip | 50677-2924
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Country | US
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Telephone | 319-352-3126
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Fax |
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Provider Business Mailing Address
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Address Line | 4115 EASTPARK RD
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City | CEDAR FALLS
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State | IA
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Zip | 50613-7512
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Country | US
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Telephone | 319-429-4509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17437
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License Number State | IA
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