Organization
DEWITT PHARMACY INC
Active
Other names
SCOTT THRIFTY WHITE DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS BOUSSELOT RPH (PRES)
(563) 659-5042
Entity
Organization
Contact information
Practice address
629 6TH AVE, DE WITT, IA 52742-1635
(563) 659-5042
(563) 659-5044
Mailing address
629 6TH AVE, DE WITT, IA 52742-1635
(563) 659-5042
(563) 659-5044
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
280
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0143404
—
IA
01
—
1610167
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/23/2006
Last updated
03/17/2010
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