Provider Demographics
NPI:1497228290
Name:MEACHAM, KIRSTEN (RPH)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SW 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:IA
Mailing Address - Zip Code:50250-2164
Mailing Address - Country:US
Mailing Address - Phone:515-523-1525
Mailing Address - Fax:
Practice Address - Street 1:303 SW 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:IA
Practice Address - Zip Code:50250-2164
Practice Address - Country:US
Practice Address - Phone:515-523-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist