=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356403018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | J RICHARD FIKUART R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2006
-----------------------------------------------------
Last Update Date | 01/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 E MADISON ST
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52353-1741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-653-6504
-----------------------------------------------------
Fax | 319-653-6008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 715 N AVENUE C
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52353-2447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-653-3064
-----------------------------------------------------
Fax | 319-653-6008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 16835
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051-035005
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------