Provider Demographics
NPI:1124856224
Name:EASTON, JOAN MC
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MC
Last Name:EASTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4595
Mailing Address - Country:US
Mailing Address - Phone:319-833-5838
Mailing Address - Fax:319-833-5839
Practice Address - Street 1:1731 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4595
Practice Address - Country:US
Practice Address - Phone:319-833-5838
Practice Address - Fax:319-833-5839
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist