Healthcare Provider Details

I. General information

NPI: 1538708466
Provider Name (Legal Business Name): BRIDGET ZITTRITSCH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 12TH AVE SW
LE MARS IA
51031-3055
US

IV. Provider business mailing address

1201 12TH AVE SW
LE MARS IA
51031-3055
US

V. Phone/Fax

Practice location:
  • Phone: 712-548-4503
  • Fax: 712-546-4463
Mailing address:
  • Phone: 712-548-4503
  • Fax: 712-546-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21003
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: