Provider Demographics
NPI:1205478922
Name:FIENUP, VIRGINIA KAY (R PH)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:KAY
Last Name:FIENUP
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 EASTPARK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7512
Mailing Address - Country:US
Mailing Address - Phone:319-429-4509
Mailing Address - Fax:
Practice Address - Street 1:110 10TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2924
Practice Address - Country:US
Practice Address - Phone:319-352-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist