Provider Demographics
NPI:1194948521
Name:ANDREESEN, JEFF L (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:L
Last Name:ANDREESEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 HALCYON DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3900
Mailing Address - Country:US
Mailing Address - Phone:563-332-7292
Mailing Address - Fax:563-332-0804
Practice Address - Street 1:2900 DEVILS GLEN RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3363
Practice Address - Country:US
Practice Address - Phone:563-332-2983
Practice Address - Fax:563-332-0804
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist