Healthcare Provider Details

I. General information

NPI: 1902012305
Provider Name (Legal Business Name): MESKWAKI PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 305TH STREET
TAMA IA
52339-9634
US

IV. Provider business mailing address

1646 305TH STREET
TAMA IA
52339-9634
US

V. Phone/Fax

Practice location:
  • Phone: 641-484-4667
  • Fax: 641-484-4875
Mailing address:
  • Phone: 641-484-4667
  • Fax: 641-484-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICK BOLTE
Title or Position: CHIEF PHARMACIST
Credential:
Phone: 641-484-4667