Individual
MR. DENNIS C BOUSSELOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
629 6TH AVE, DEWITT, IA 52742
(563) 659-5042
(563) 659-5044
Mailing address
2433 259TH AVE, DEWITT, IA 52742
(563) 659-9804
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14363
IA
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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