Healthcare Provider Details

I. General information

NPI: 1497268619
Provider Name (Legal Business Name): SHAVEA NOAMI ZAPATA JUAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 W 4TH ST
OTTUMWA IA
52501-2517
US

IV. Provider business mailing address

327 W 4TH ST
OTTUMWA IA
52501-2517
US

V. Phone/Fax

Practice location:
  • Phone: 641-226-5077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23186
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: