MEDICARE: JENIFER RUTH DEUTMEYER MCGOVERN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20225	IA

General Provider Information

NPI Number	:	1245855758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER RUTH DEUTMEYER MCGOVERN PHARMD

Provider Business Mailing Address
First Line	:	2939 197TH ST
Second Line	:
City	:	EARLVILLE
State	:	IA
Zip	:	52041-8603
Country	:	US
Telephone Number	:	563-845-1508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W MAIN ST
Second Line	:
City	:	MANCHESTER
State	:	IA
Zip	:	52057-2305
Country	:	US
Telephone Number	:	563-927-4988
Fax Number	:	563-927-3314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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