Provider Demographics
NPI:1154962330
Name:JOBST, MARK (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JOBST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N CHESTNUT AVE
Mailing Address - Street 2:PO BX 8
Mailing Address - City:EARLHAM
Mailing Address - State:IA
Mailing Address - Zip Code:50072
Mailing Address - Country:US
Mailing Address - Phone:515-758-2174
Mailing Address - Fax:515-758-2188
Practice Address - Street 1:115 N CHESTNUT AVE
Practice Address - Street 2:PO BX 8
Practice Address - City:EARLHAM
Practice Address - State:IA
Practice Address - Zip Code:50072
Practice Address - Country:US
Practice Address - Phone:515-758-2174
Practice Address - Fax:515-758-2188
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14772OtherSTATE PHAMACY LICENSE