Provider Demographics
NPI:1902578727
Name:RADEMACHER, BRUCE EDWIN (RPH)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:EDWIN
Last Name:RADEMACHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2689
Mailing Address - Country:US
Mailing Address - Phone:319-339-3637
Mailing Address - Fax:319-339-3867
Practice Address - Street 1:500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2689
Practice Address - Country:US
Practice Address - Phone:319-339-3637
Practice Address - Fax:319-339-3867
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist