Provider Demographics
NPI:1215907134
Name:WESTER DRUG, INC
Entity type:Organization
Organization Name:WESTER DRUG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:563-732-5238
Mailing Address - Street 1:400 OVESON DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:WILTON
Mailing Address - State:IA
Mailing Address - Zip Code:52778-9612
Mailing Address - Country:US
Mailing Address - Phone:563-732-5238
Mailing Address - Fax:
Practice Address - Street 1:400 OVESON DR
Practice Address - Street 2:SUITE #102
Practice Address - City:WILTON
Practice Address - State:IA
Practice Address - Zip Code:52778-9612
Practice Address - Country:US
Practice Address - Phone:563-732-5238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA162214333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0442079Medicaid