Provider Demographics
NPI:1437487162
Name:BESCH, DOUGLAS M (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:BESCH
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W. RIDGEWAY AVE.
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4233
Mailing Address - Country:US
Mailing Address - Phone:319-433-0490
Mailing Address - Fax:319-433-0493
Practice Address - Street 1:101 W. RIDGEWAY AVE.
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4233
Practice Address - Country:US
Practice Address - Phone:319-433-0490
Practice Address - Fax:319-433-0493
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291863183500000X
IA21176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist