Healthcare Provider Details

I. General information

NPI: 1467547653
Provider Name (Legal Business Name): ROBERT ALLEN STESSMAN R.PH. B.S. PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 MAIN STREET
MANNING IA
51455
US

IV. Provider business mailing address

1010 CENTER ST
MANNING IA
51455-1527
US

V. Phone/Fax

Practice location:
  • Phone: 712-655-9490
  • Fax: 712-655-2295
Mailing address:
  • Phone: 712-210-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number16266
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16266
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: