Healthcare Provider Details

I. General information

NPI: 1275611907
Provider Name (Legal Business Name): KEWI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SW 7TH ST
STUART IA
50250-2164
US

IV. Provider business mailing address

PO BOX 159
STUART IA
50250-0159
US

V. Phone/Fax

Practice location:
  • Phone: 515-523-1525
  • Fax: 515-523-1451
Mailing address:
  • Phone: 515-523-1525
  • Fax: 515-523-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number462
License Number StateIA

VIII. Authorized Official

Name: MRS. KELLY D. BUMP
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 515-523-1525