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General NPI Number Information
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NPI Number | 1962078964
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Entity Type | Individual
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Provider Name | NATHAN MOTT
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Gender | Male
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 3804 METRO DR
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-7732
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Country | US
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Telephone | 712-309-3381
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CVS DR # 1075
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City | WOONSOCKET
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State | RI
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Zip | 02895-6146
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Country | US
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Telephone |
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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 | 23878
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License Number State | IA
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