Healthcare Provider Details

I. General information

NPI: 1073154035
Provider Name (Legal Business Name): AMY POWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 LINCOLN WAY
AMES IA
50014-8533
US

IV. Provider business mailing address

1200 UNIVERSITY AVE STE 200
DES MOINES IA
50314-2355
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-0638
  • Fax:
Mailing address:
  • Phone: 515-248-1490
  • Fax: 515-248-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22009
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: