MEDICARE: MR. DOUGLAS ALAN WETRICH RPH

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	183500000X	Pharmacist	16034	WA
2	183500000X	Pharmacist	17405	IA

General Provider Information

NPI Number	:	1871570036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS ALAN WETRICH RPH

Provider Business Mailing Address
First Line	:	21 BIRCHWOOD DR
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-1416
Country	:	US
Telephone Number	:	641-684-6788
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 N MADISON ST
Second Line	:
City	:	BLOOMFIELD
State	:	IA
Zip	:	52537-1271
Country	:	US
Telephone Number	:	641-664-2145
Fax Number	:	641-664-2421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/08/2007

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