Provider Demographics
NPI:1588791354
Name:PAUL, JILLANE ELISE (RPH)
Entity type:Individual
Prefix:MRS
First Name:JILLANE
Middle Name:ELISE
Last Name:PAUL
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 1:702 NE BARCLAY CIR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4526
Mailing Address - Country:US
Mailing Address - Phone:515-963-8102
Mailing Address - Fax:
Practice Address - Street 1:5750 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1215
Practice Address - Country:US
Practice Address - Phone:515-270-9212
Practice Address - Fax:515-270-0860
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist