MEDICARE: DR. JONATHAN BARRY HJELM PHARM.D

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	16936-40	WI

General Provider Information

NPI Number	:	1649660499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN BARRY HJELM PHARM.D

Provider Business Mailing Address
First Line	:	2503 N HILLCREST PKWY
Second Line	:
City	:	ALTOONA
State	:	WI
Zip	:	54720-2569
Country	:	US
Telephone Number	:	715-852-2991
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 WISCONSIN ST
Second Line	:	SUITE 18-101
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-3588
Country	:	US
Telephone Number	:	715-852-2991
Fax Number	:

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

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	02/02/2015

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