=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669097887
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NALINH MAVEN SITHEP PHARMD.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2020
-----------------------------------------------------
Last Update Date | 06/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 IOWA SPEEDWAY DR
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50208-9484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-792-9237
-----------------------------------------------------
Fax | 641-792-9318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4414 SW WALNUT ST
-----------------------------------------------------
City | ANKENY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50023-8344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-360-8598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 20020
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------