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General NPI Number Information
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NPI Number | 1033403159
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Entity Type | Individual
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Provider Name | DAVID WOLTZ PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 1071 W CARL SANDBURG DR
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City | GALESBURG
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State | IL
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Zip | 61401-1343
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Country | US
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Telephone | 309-344-7886
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Fax |
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Provider Business Mailing Address
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Address Line | 4914 EAGLE CT
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City | DAVENPORT
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State | IA
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Zip | 52807-3865
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Country | US
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Telephone | 515-988-2865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.293616
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1-14244
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License Number State | KS
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