Provider Demographics
NPI:1811579329
Name:WITT FAMILY PHARMACY INC.
Entity type:Organization
Organization Name:WITT FAMILY PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:712-644-2160
Mailing Address - Street 1:3410 PRAIRIE SOUTH CIR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:IA
Mailing Address - Zip Code:51546-5115
Mailing Address - Country:US
Mailing Address - Phone:712-574-2108
Mailing Address - Fax:
Practice Address - Street 1:103 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:IA
Practice Address - Zip Code:51546-1335
Practice Address - Country:US
Practice Address - Phone:712-644-2160
Practice Address - Fax:712-644-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy