Provider Demographics
NPI:1457162224
Name:JAGIELLO, LORRIE (RPH)
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:
Last Name:JAGIELLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8981 PRIMO LN
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8465
Mailing Address - Country:US
Mailing Address - Phone:515-480-6208
Mailing Address - Fax:
Practice Address - Street 1:900 SE LAUREL ST
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9100
Practice Address - Country:US
Practice Address - Phone:515-904-0987
Practice Address - Fax:515-282-8450
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist