=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699986554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JARED FRANKLIN STEWART PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3221 SE 14TH ST
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50320-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-246-1390
-----------------------------------------------------
Fax | 515-280-5106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5430 SE 28TH ST
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50320-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-255-4767
-----------------------------------------------------
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 | 19684
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------