Healthcare Provider Details

I. General information

NPI: 1689716938
Provider Name (Legal Business Name): KEVIN LEW BEBOUT R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DRIVE DEPARTMENT OF PHARMACEUTICAL CARE CC-101 GH
IOWA CITY IA
52242
US

IV. Provider business mailing address

409 OAKLAND AVE
IOWA CITY IA
52240-6236
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-2577
  • Fax:
Mailing address:
  • Phone: 319-351-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16460
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: