MEDICARE: MR. GARY L LEVINE R.PH., CDM

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	16727	IA

General Provider Information

NPI Number	:	1386782829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY L LEVINE R.PH., CDM

Provider Business Mailing Address
First Line	:	850 CUMMINS PKWY
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312-1133
Country	:	US
Telephone Number	:	515-277-7448
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 UNIVERSITY AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-3533
Country	:	US
Telephone Number	:	515-633-8606
Fax Number	:	515-866-6309

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

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	07/08/2007

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