MEDICARE: DRAKE UNIVERSITY COLLEGE OF PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	727	IA

General Provider Information

NPI Number	:	1023451721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAKE UNIVERSITY COLLEGE OF PHARMACY

Provider Business Mailing Address
First Line	:	2802 FOREST AVE
Second Line	:	CLINE HALL
City	:	DES MOINES
State	:	IA
Zip	:	50311-3010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 FOREST AVE
Second Line	:	CLINE HALL
City	:	DES MOINES
State	:	IA
Zip	:	50311-3010
Country	:	US
Telephone Number	:	515-271-1849
Fax Number	:

Authorized Official
Title or Position	:	DEPARTMENT CHAIR
Name	:	DR. TIMOTHY WELTY
Credential	:
Telephone Number	:	515-271-1849

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/11/2013

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