MEDICARE: DR. KELLY MARIE DIGHTON PHARM.D

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	051.292755	IL
2	183500000X	Pharmacist	20827	IA

General Provider Information

NPI Number	:	1720358609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY MARIE DIGHTON PHARM.D

Provider Business Mailing Address
First Line	:	2710 SAINT FRANCIS DR STE 101
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5633
Country	:	US
Telephone Number	:	319-272-5700
Fax Number	:	319-272-0188

Provider Business Practice Location Address
First Line	:	2710 SAINT FRANCIS DR STE 101
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5633
Country	:	US
Telephone Number	:	319-272-5700
Fax Number	:	319-272-0188

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

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	06/25/2025

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