Provider Demographics
NPI:1285256560
Name:NARDINI, LANDON JAY (PHARMD)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:JAY
Last Name:NARDINI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4233
Mailing Address - Country:US
Mailing Address - Phone:319-433-0490
Mailing Address - Fax:319-433-0493
Practice Address - Street 1:111 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4233
Practice Address - Country:US
Practice Address - Phone:319-433-0490
Practice Address - Fax:319-433-0493
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist