Healthcare Provider Details

I. General information

NPI: 1386059640
Provider Name (Legal Business Name): DAVID SCOFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
DUBUQUE IA
52001-6814
US

IV. Provider business mailing address

703 MAIN STREET
DUBUQUE IA
52001
US

V. Phone/Fax

Practice location:
  • Phone: 563-588-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16520
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14613-040
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.035330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: