Healthcare Provider Details

I. General information

NPI: 1497228290
Provider Name (Legal Business Name): KIRSTEN MEACHAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SW 7TH ST STE A
STUART IA
50250-2164
US

IV. Provider business mailing address

303 SW 7TH ST STE A
STUART IA
50250-2164
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19496
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: