Healthcare Provider Details

I. General information

NPI: 1871570036
Provider Name (Legal Business Name): DOUGLAS ALAN WETRICH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N MADISON ST
BLOOMFIELD IA
52537-1271
US

IV. Provider business mailing address

21 BIRCHWOOD DR
OTTUMWA IA
52501-1416
US

V. Phone/Fax

Practice location:
  • Phone: 641-664-2145
  • Fax: 641-664-2421
Mailing address:
  • Phone: 641-684-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16034
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17405
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: