1922091925 NPI number — PHARMACY ASSOCIATES OF CARROLL, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922091925 NPI number — PHARMACY ASSOCIATES OF CARROLL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACY ASSOCIATES OF CARROLL, 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:
Provider Other Organization Name Type Code:
6
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:
1922091925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 HWY 30 WEST, SUITE 140C
Provider Second Line Business Mailing Address:
PO BOX 157
Provider Business Mailing Address City Name:
CARROLL
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51401-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-792-2671
Provider Business Mailing Address Fax Number:
712-792-3951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 HWY 30 WEST,
Provider Second Line Business Practice Location Address:
SUITE 140C
Provider Business Practice Location Address City Name:
CARROLL
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51401-0157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-792-2671
Provider Business Practice Location Address Fax Number:
712-792-3951
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARKWAY
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
712-792-2671

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  1253 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 1253 , 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: 0446161 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1622186 . This is a "NABP NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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