Healthcare Provider Details

I. General information

NPI: 1750713681
Provider Name (Legal Business Name): WILLIAM PAUL TVEITE R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 LOGAN AVE
WATERLOO IA
50703-1916
US

IV. Provider business mailing address

1410 E FRANKLIN AVE
INDIANOLA IA
50125-1547
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3510
  • Fax:
Mailing address:
  • Phone: 515-321-1031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15326
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: