Provider Demographics
NPI:1497235873
Name:BUELTEL, STACY (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BUELTEL
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 1:50 ASH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9316
Mailing Address - Country:US
Mailing Address - Phone:641-226-1667
Mailing Address - Fax:
Practice Address - Street 1:919 HIGHWAY 1 W
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-4225
Practice Address - Country:US
Practice Address - Phone:319-337-8862
Practice Address - Fax:319-688-9520
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist