Provider Demographics
NPI:1508488990
Name:STARK, DAVID W (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:STARK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 26TH ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4428
Mailing Address - Country:US
Mailing Address - Phone:515-291-1935
Mailing Address - Fax:
Practice Address - Street 1:632 S OAK ST
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-9509
Practice Address - Country:US
Practice Address - Phone:641-648-4255
Practice Address - Fax:641-648-4449
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist