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NPI Code Detail

MEDICARE: CLINTON MEDICAL CLINIC PHARMACY INC

MEDICARE: CLINTON MEDICAL CLINIC PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0002XClinic Pharmacy75IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710995758
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINTON MEDICAL CLINIC PHARMACY INC
Provider Business Mailing Address
First Line : 221 MAIN AVE
Second Line :
City : CLINTON
State : IA
Zip : 52732-2241
Country : US
Telephone Number : 563-242-1724
Fax Number : 563-243-8435
Provider Business Practice Location Address
First Line : 221 MAIN AVE
Second Line :
City : CLINTON
State : IA
Zip : 52732-2241
Country : US
Telephone Number : 563-242-1724
Fax Number : 563-243-8435
Authorized Official
Title or Position : PRESIDENT
Name : MR. GERALD W WHEELER
Credential : RPH
Telephone Number : 563-242-1724
Provider Enumeration Date : 08/04/2006
Last Update Date : 06/27/2011

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Directions to “CLINTON MEDICAL CLINIC PHARMACY INC ” Practice Location

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