1356374623 NPI number — FOODS, INC

Table of content: (NPI 1356374623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356374623 NPI number — FOODS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOODS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DAHL'S PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356374623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8700 HICKMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIVE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50325-4326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-276-8784
Provider Business Mailing Address Fax Number:
515-331-3152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8700 HICKMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIVE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50325-4326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-276-8784
Provider Business Practice Location Address Fax Number:
515-331-3152
Provider Enumeration Date:
07/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORROW
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
515-255-8642

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  577 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1604138 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0076471 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: I20027 . This is a "MEDICARE FLU ROSTER" identifier . This identifiers is of the category "OTHER".