Provider Demographics
NPI:1700281995
Name:DEWALSCHE, ELIZABETH M (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:DEWALSCHE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2645
Mailing Address - Country:US
Mailing Address - Phone:563-242-0626
Mailing Address - Fax:
Practice Address - Street 1:1726 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2645
Practice Address - Country:US
Practice Address - Phone:563-242-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22312183500000X
IL051.297773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist