MEDICARE: CENTRAL CITY FAMILY 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
1	183500000X	Pharmacist	1055	IA

Other Identifiers

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

General Provider Information

NPI Number	:	1750360186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL CITY FAMILY PHARMACY, INC.

Provider Business Mailing Address
First Line	:	900 BANK CT
Second Line	:
City	:	CENTER POINT
State	:	IA
Zip	:	52213-9477
Country	:	US
Telephone Number	:	319-849-2799
Fax Number	:	319-849-1536

Provider Business Practice Location Address
First Line	:	900 BANK CT
Second Line	:
City	:	CENTER POINT
State	:	IA
Zip	:	52213-9477
Country	:	US
Telephone Number	:	319-849-2799
Fax Number	:	319-849-1536

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MEGAN MANDERSCHEID
Credential	:	PHARMD
Telephone Number	:	319-438-1988

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	04/12/2021

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