Healthcare Provider Details

I. General information

NPI: 1356403018
Provider Name (Legal Business Name): J RICHARD FIKUART R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MADISON ST
WASHINGTON IA
52353-1741
US

IV. Provider business mailing address

715 N AVENUE C
WASHINGTON IA
52353-2447
US

V. Phone/Fax

Practice location:
  • Phone: 319-653-6504
  • Fax: 319-653-6008
Mailing address:
  • Phone: 319-653-3064
  • Fax: 319-653-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16835
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-035005
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: