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General NPI Number Information
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NPI Number | 1538382874
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Entity Type | Individual
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Provider Name | JANE ANN DEJONG R.PH.
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 426 N MICHIGAN ST
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City | SOUTH BEND
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State | IN
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Zip | 46601-1228
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Country | US
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Telephone | 574-234-3184
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Fax |
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Provider Business Mailing Address
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Address Line | 51639 PEBBLE BROOKE DR
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City | GRANGER
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State | IN
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Zip | 46530-5045
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Country | US
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Telephone |
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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 | 26018159A
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License Number State | IN
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