Healthcare Provider Details

I. General information

NPI: 1942339494
Provider Name (Legal Business Name): ALISSA LYNN BUBON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 E EUCLID AVE
DES MOINES IA
50317-6046
US

IV. Provider business mailing address

714 NE HAYES DR
ANKENY IA
50021-2086
US

V. Phone/Fax

Practice location:
  • Phone: 515-262-2108
  • Fax: 515-262-7922
Mailing address:
  • Phone: 515-965-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19983
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: