Provider Demographics
NPI:1356403018
Name:FIKUART, J RICHARD (RPH)
Entity type:Individual
Prefix:MR
First Name:J RICHARD
Middle Name:
Last Name:FIKUART
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 1:715 N AVENUE C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-2447
Mailing Address - Country:US
Mailing Address - Phone:319-653-3064
Mailing Address - Fax:319-653-6008
Practice Address - Street 1:120 E MADISON ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1741
Practice Address - Country:US
Practice Address - Phone:319-653-6504
Practice Address - Fax:319-653-6008
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16835183500000X
IL051-035005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist