Organization
DEWITT PHARMACY INC
Active
Other names
DEWITT PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS BOUSSELOT RPH (PRESIDENT)
(563) 659-5042
Entity
Organization
Contact information
Practice address
609 7TH AVE, DEWITT, IA 52742
(563) 659-5041
Mailing address
609 7TH AVE, DEWITT, IA 52742
(563) 659-5041
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
1212
IA
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0491548
—
IA
01
—
1622376
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/11/2006
Last updated
08/28/2007
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