Provider Demographics
NPI:1902426216
Name:KALASEK, DOUGLAS DEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DEAN
Last Name:KALASEK
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 1:3402 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-5622
Mailing Address - Country:US
Mailing Address - Phone:402-639-8150
Mailing Address - Fax:
Practice Address - Street 1:757 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-4197
Practice Address - Country:US
Practice Address - Phone:712-328-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist