St Anthony Wall Lake Phcy

LBN: St Anthony Wall Lake Pharmacy
St Anthony Wall Lake Phcy is an health care organization with primary practice located at 311 W 1St St , Wall Lake IA 51466-7014. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. St Anthony Wall Lake Pharmacy can be contacted via phone (712) 664-2801, or through Fleshner, Jerry via phone (712) 664-2801.

Contact Information

Primary practice address
311 W 1St St Wall Lake IA 51466-7014
Phone: (712) 664-2801
Fax: (712) 664-2820
Website:
Map and Directions
Authorized official contact:
Name: Fleshner, Jerry
Phone: (712) 664-2801

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 966 Iowa

Profile Details

NPI number 1821161936
LBN Legal business name St Anthony Wall Lake Pharmacy
DBA Doing business as St Anthony Wall Lake Phcy
Authorized official Fleshner, Jerry
Entity Organization
Organization subpart 1 No
Enumeration date Nov 16th, 2006
Last updated Jul 31st, 2007 - about 19 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821161936 NPPES
Iowa MEDICAID 0104836
Iowa Other 1617488

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