Provider Demographics
NPI:1780807552
Name:PUFFETT, ANTHONY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PUFFETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SIOUX VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1205
Mailing Address - Country:US
Mailing Address - Phone:712-225-3368
Mailing Address - Fax:
Practice Address - Street 1:206 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1825
Practice Address - Country:US
Practice Address - Phone:712-225-2320
Practice Address - Fax:712-225-2319
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist