MEDICARE: SHANDA HILARY PTACEK PHARMD

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	22595	IA

General Provider Information

NPI Number	:	1356727424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANDA HILARY PTACEK PHARMD

Provider Business Mailing Address
First Line	:	1905 N 2ND ST
Second Line	:
City	:	CLINTON
State	:	IA
Zip	:	52732-2537
Country	:	US
Telephone Number	:	563-243-2247
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 N 2ND ST
Second Line	:
City	:	CLINTON
State	:	IA
Zip	:	52732-2537
Country	:	US
Telephone Number	:	563-243-2247
Fax Number	:

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

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/30/2015

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