=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457162224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORRIE JAGIELLO RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2025
-----------------------------------------------------
Last Update Date | 01/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 SE LAUREL ST
-----------------------------------------------------
City | WAUKEE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50263-9100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-904-0987
-----------------------------------------------------
Fax | 515-282-8450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8981 PRIMO LN
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-8465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-480-6208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 18803
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------