| NPI | 1972683373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK G. ROGERS President 563-421-6513 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: IA 369) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: IA 369) |
| 3336H0001X Pharmacy Home Infusion Therapy Pharmacy (Licence: IA 369) | |
| 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: IA 369) | |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2022-02-04 |