Healthcare Provider Details

I. General information

NPI: 1376642835
Provider Name (Legal Business Name): LETSCHE APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 NORTH MAIN ST
HOLSTEIN IA
51025
US

IV. Provider business mailing address

PO BOX 70
HOLSTEIN IA
51025-0070
US

V. Phone/Fax

Practice location:
  • Phone: 712-368-4549
  • Fax:
Mailing address:
  • Phone: 712-368-4549
  • Fax: 712-368-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17926
License Number StateIA

VIII. Authorized Official

Name: MARY LETSCHE
Title or Position: OWNER
Credential:
Phone: 712-368-4549