Healthcare Provider Details

I. General information

NPI: 1639104763
Provider Name (Legal Business Name): BILL MATHER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SW KENT ST
GREENFIELD IA
50849-1379
US

IV. Provider business mailing address

202 SW KENT ST
GREENFIELD IA
50849-1379
US

V. Phone/Fax

Practice location:
  • Phone: 641-743-2201
  • Fax: 641-743-2203
Mailing address:
  • Phone: 641-743-2201
  • Fax: 641-743-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13566
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: