Healthcare Provider Details

I. General information

NPI: 1972643914
Provider Name (Legal Business Name): CONSULTANT PHARMACISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 ILLINOIS STREET
SIDNEY IA
51652
US

IV. Provider business mailing address

714 ILLINOIS STREET PO BOX 360
SIDNEY IA
51652
US

V. Phone/Fax

Practice location:
  • Phone: 712-374-2513
  • Fax: 712-374-3171
Mailing address:
  • Phone: 712-374-2513
  • Fax: 712-374-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number507
License Number StateIA

VIII. Authorized Official

Name: MRS. ANGELA ETTLEMAN
Title or Position: OWNER
Credential: CPHT
Phone: 712-374-2513