Organization
DEWITT PHARMACY INC
Active
Other names
SCOTT DRUG CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS BOUSSELOT RPH (PRESIDENT)
(563) 659-5042
Entity
Organization
Contact information
Practice address
1021 11TH ST, DE WITT, IA 52742-1209
(563) 659-8910
(563) 659-8411
Mailing address
629 6TH AVE, DE WITT, IA 52742-1635
(563) 659-5042
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
1228
IA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0419267
—
IA
01
—
1621831
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/10/2006
Last updated
08/28/2007
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