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General NPI Number Information
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NPI Number | 1902350812
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Entity Type | Organization
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Legal Business Name | BLANK CANCER & BLOOD DISORDERS CENTER
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 1215 PLEASANT ST SUITE 514
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City | DES MOINES
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State | IA
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Zip | 50309-1416
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Country | US
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Telephone | 515-241-8042
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Fax | 515-241-8988
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Provider Business Mailing Address
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Address Line | 1215 PLEASANT ST SUITE 514
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City | DES MOINES
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State | IA
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Zip | 50309-1416
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Country | US
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Telephone | 515-241-8042
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Fax | 515-241-8988
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Authorized Official
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Title or Position | PEDIATRIC ONCOLOGY PHARMACIST
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Name | DR. KATHRYN NICOLE JUHL
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Credential | PHARMD
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Telephone | 515-241-8042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | 20163
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License Number State | IA
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