Organization
DEWITT PHARMACY INC
Active
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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