Organization
KMART PHARMACY # 4156
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRESTON J WITT RPH (PHARMACIST MANAGER)
(515) 270-2623
Entity
Organization
Contact information
Practice address
7501 HICKMAN RD, URBANDALE, IA 50322-4603
(515) 270-2623
Mailing address
7501 HICKMAN RD, URBANDALE, IA 50322-4603
(515) 270-2623
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
16824
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417988478
GROUP NPI KMART PHARMACY 4156
—
Enumeration date
04/23/2016
Last updated
04/23/2016
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