Provider Demographics
NPI:1144997834
Name:NELSON, TARYN LEIGH (PHARMD)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:LEIGH
Last Name:NELSON
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 1:405 S SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-3330
Mailing Address - Country:US
Mailing Address - Phone:641-782-6558
Mailing Address - Fax:641-782-7346
Practice Address - Street 1:405 S SUMNER AVE
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-3330
Practice Address - Country:US
Practice Address - Phone:641-782-6558
Practice Address - Fax:641-782-7346
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA219701835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist