Provider Demographics
NPI:1245896752
Name:WAITE, PAULA LYNN (RPH)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:LYNN
Last Name:WAITE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-3766
Mailing Address - Country:US
Mailing Address - Phone:641-683-1356
Mailing Address - Fax:
Practice Address - Street 1:1940 VENTURE DR
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3766
Practice Address - Country:US
Practice Address - Phone:641-919-9025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18909OtherPHARMACY LICENSE