Provider Demographics
NPI:1891897393
Name:MAIER, EDWARD LEE (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEE
Last Name:MAIER
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 1:205 S 5TH ST
Mailing Address - Street 2:P.O. BOX 67
Mailing Address - City:MAPLETON
Mailing Address - State:IA
Mailing Address - Zip Code:51034-1203
Mailing Address - Country:US
Mailing Address - Phone:712-881-1033
Mailing Address - Fax:712-881-1206
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:IA
Practice Address - Zip Code:51034-1212
Practice Address - Country:US
Practice Address - Phone:712-881-1033
Practice Address - Fax:712-881-1206
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13780OtherSTSTE REGISTRATION