Active NPI
Daniel Petefish, PHARMD
- Pharmacist
- Bettendorf, IA
National Provider Identifier
1043410939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19830
- Practice address
- 4500 Utica Ridge Rd
Bettendorf, IA 52722-1626 - Phone
- (563) 742-2410
- NPI assigned
- Jul 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19830 | IA | Primary |
Addresses
Primary practice location
4500 Utica Ridge Rd
Bettendorf, IA 52722-1626
Mailing address
4500 Utica Ridge Rd
Bettendorf, IA 52722-1626
Phone (563) 742-2410
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19830 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236643200000",
"number": "1043410939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 UTICA RIDGE RD",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527221626",
"telephone_number": "563-742-2410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 UTICA RIDGE RD",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527221626",
"telephone_number": "563-742-2410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETEFISH",
"first_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-19",
"last_updated": "2009-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "19830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bettendorf, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.