Healthcare Provider Details

I. General information

NPI: 1689594988
Provider Name (Legal Business Name): ISABELLA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BELLA SMITH

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 INGERSOLL AVE STE 102
DES MOINES IA
50309-3332
US

IV. Provider business mailing address

536 TRAIL RDG
COUNCIL BLUFFS IA
51503-0232
US

V. Phone/Fax

Practice location:
  • Phone: 515-657-8896
  • Fax: 515-657-8897
Mailing address:
  • Phone: 712-314-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25591
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: