=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376642835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LETSCHE APOTHECARY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 NORTH MAIN ST
-----------------------------------------------------
City | HOLSTEIN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-368-4549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 70
-----------------------------------------------------
City | HOLSTEIN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51025-0070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-368-4549
-----------------------------------------------------
Fax | 712-368-2124
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARY LETSCHE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-368-4549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 17926
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------