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NPI Code Detail

MEDICARE: GAIL WIDEMAN PHARMD

MEDICARE: GAIL WIDEMAN 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
1183500000XPharmacist20073IA

General Provider Information

NPI Number : 1740813815
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAIL WIDEMAN PHARMD
Provider Business Mailing Address
First Line : 3140 AGENCY ST
Second Line :
City : BURLINGTON
State : IA
Zip : 52601-1977
Country : US
Telephone Number : 319-752-2773
Fax Number : 319-754-8440
Provider Business Practice Location Address
First Line : 3140 AGENCY ST
Second Line :
City : BURLINGTON
State : IA
Zip : 52601-1977
Country : US
Telephone Number : 319-752-2773
Fax Number : 319-754-8440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2020
Last Update Date : 02/18/2020

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Directions to “ GAIL WIDEMAN PHARMD” Practice Location

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