Provider Demographics
NPI:1679614952
Name:STEGALL, JILL (PHARMD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:STEGALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:MINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2710 SAINT FRANCIS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5633
Mailing Address - Country:US
Mailing Address - Phone:319-272-5700
Mailing Address - Fax:319-272-0188
Practice Address - Street 1:2710 SAINT FRANCIS DR STE 101
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5633
Practice Address - Country:US
Practice Address - Phone:319-272-5700
Practice Address - Fax:319-272-0188
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist