Provider Demographics
NPI:1396380069
Name:DORHOUT, ALYSSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:DORHOUT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 METRO DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-7732
Mailing Address - Country:US
Mailing Address - Phone:712-309-3381
Mailing Address - Fax:
Practice Address - Street 1:3804 METRO DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7732
Practice Address - Country:US
Practice Address - Phone:402-415-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist