Individual
PORTIA W LICHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R PH
Contact information
Practice address
920 BREMER RD, WAVERLY, IA 50677-4141
(319) 352-4756
Mailing address
920 BREMER RD, WAVERLY, IA 50677-4141
(319) 352-4756
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13316
IA
Other
Enumeration date
05/24/2013
Last updated
05/24/2013
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