Dewitt Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · De Witt, IA
NPI 1174630735 · NPPES record last updated Mar 17, 2010
Key facts
- NPI
- 1174630735
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 280 (IA)
- Legal business name
- DEWITT PHARMACY INC
- Practice address
- 629 6TH Ave
De Witt, IA 52742-1635 - Phone
- (563) 659-5042
- Fax
- (563) 659-5044
- NPI assigned
- Aug 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Dennis Bousselot, RPH
- Title
- Pres
- Phone
- (563) 659-5042
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 280 | IA | Yes |
Addresses
Primary practice location
629 6TH Ave
De Witt, IA 52742-1635
Mailing address
629 6TH Ave
De Witt, IA 52742-1635
Phone (563) 659-5042
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0143404 | Medicaid | IA | |
| 1610167 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names
- SCOTT THRIFTY WHITE DRUG
Other providers in De Witt, IA
- Dewitt Dental Associates, PC
- Dewitt ER PC Services
- Dewitt Family Dentistry P.C.
- Dewitt Family Practice, PLLC
- Dewitt Pharmacy Inc
- Morgan E Dewitt
- Kristen R Dunne
- Eden Chiropractic Wellness Center
- Troy Eden
- Allison Edmunds
All providers in De Witt, IA · Community/Retail Pharmacy in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.