Provider Demographics
NPI:1902350812
Name:BLANK CANCER & BLOOD DISORDERS CENTER
Entity Type:Organization
Organization Name:BLANK CANCER & BLOOD DISORDERS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC ONCOLOGY PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JUHL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:515-241-8042
Mailing Address - Street 1:1215 PLEASANT ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1416
Mailing Address - Country:US
Mailing Address - Phone:515-241-8042
Mailing Address - Fax:515-241-8988
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:SUITE 514
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-241-8042
Practice Address - Fax:515-241-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20163261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology