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General NPI Number Information
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NPI Number | 1386782829
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Entity Type | Individual
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Provider Name | GARY L LEVINE R.PH., CDM
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Gender | Male
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Dates
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Enumeration Date | 02/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4100 UNIVERSITY AVE
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City | DES MOINES
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State | IA
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Zip | 50311-3533
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Country | US
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Telephone | 515-633-8606
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Fax | 515-866-6309
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Provider Business Mailing Address
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Address Line | 850 CUMMINS PKWY
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City | DES MOINES
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State | IA
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Zip | 50312-1133
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Country | US
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Telephone | 515-277-7448
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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 | 16727
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License Number State | IA
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