Healthcare Provider Details

I. General information

NPI: 1518058437
Provider Name (Legal Business Name): MICHAEL G WURTH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HWY 6 WEST
IOWA CITY IA
52246
US

IV. Provider business mailing address

505 REDBIRD RUN
TIFFIN IA
52340
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-0581
  • Fax: 319-339-7042
Mailing address:
  • Phone: 319-545-1755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17589
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: