Provider Demographics
NPI:1912274077
Name:NIESS, AMY JEAN (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:NIESS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 SE BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4034
Mailing Address - Country:US
Mailing Address - Phone:515-745-0008
Mailing Address - Fax:
Practice Address - Street 1:4600 86TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-1026
Practice Address - Country:US
Practice Address - Phone:515-252-7355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist