Provider Demographics
NPI:1578612768
Name:WESTER DRUG, INC
Entity Type:Organization
Organization Name:WESTER DRUG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CRC, CPHT
Authorized Official - Phone:563-732-5238
Mailing Address - Street 1:400 OVESEN DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILTON
Mailing Address - State:IA
Mailing Address - Zip Code:52778
Mailing Address - Country:US
Mailing Address - Phone:563-732-5238
Mailing Address - Fax:563-732-5239
Practice Address - Street 1:400 OVESEN DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WILTON
Practice Address - State:IA
Practice Address - Zip Code:52778
Practice Address - Country:US
Practice Address - Phone:563-732-5238
Practice Address - Fax:563-732-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IA1252332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0442079Medicaid
IA1578612768Medicaid
IA0442078Medicaid
IA0442079Medicaid