Provider Demographics
NPI:1366713489
Name:MASENGARB, JAMES STEWART (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STEWART
Last Name:MASENGARB
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:STEWART
Other - Last Name:MASENGRB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:601 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-5950
Mailing Address - Country:US
Mailing Address - Phone:319-752-7929
Mailing Address - Fax:
Practice Address - Street 1:201 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5738
Practice Address - Country:US
Practice Address - Phone:319-753-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAM13506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist