Provider Demographics
NPI:1013137595
Name:NEDVED, MAX R (RPH)
Entity Type:Individual
Prefix:MR
First Name:MAX
Middle Name:R
Last Name:NEDVED
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 1:2042 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-7484
Mailing Address - Country:US
Mailing Address - Phone:515-543-5703
Mailing Address - Fax:
Practice Address - Street 1:800 OHIO ST
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2824
Practice Address - Country:US
Practice Address - Phone:515-832-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0098673Medicaid
IA0213410050Medicare ID - Type UnspecifiedMEDICARE NUMBER