Provider Demographics
NPI:1124643895
Name:WITTENBURG, ZACHARY ALLAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ALLAN
Last Name:WITTENBURG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52336-9633
Mailing Address - Country:US
Mailing Address - Phone:319-560-0556
Mailing Address - Fax:
Practice Address - Street 1:5491 HIGHWAY 151
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3892
Practice Address - Country:US
Practice Address - Phone:319-447-2870
Practice Address - Fax:319-447-2872
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist