MEDICARE: MR. DOUGLAS J FITZGERALD R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	F-15485	IA

General Provider Information

NPI Number	:	1285635854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS J FITZGERALD R.PH

Provider Business Mailing Address
First Line	:	3631 SW 34TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-1937
Country	:	US
Telephone Number	:	515-287-3619
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 30TH ST
Second Line	:	PHARMACY DEPT MAIL STOP 119
City	:	DES MOINES
State	:	IA
Zip	:	50310-5876
Country	:	US
Telephone Number	:	515-699-5999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	07/08/2007

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