Healthcare Provider Details

I. General information

NPI: 1629568795
Provider Name (Legal Business Name): HERRON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 NILE KINNICK DR S STE 1
ADEL IA
50003-2071
US

IV. Provider business mailing address

628 NILE KINNICK DR S STE 1
ADEL IA
50003-2071
US

V. Phone/Fax

Practice location:
  • Phone: 515-993-1119
  • Fax: 866-684-2966
Mailing address:
  • Phone: 360-420-6401
  • Fax: 515-993-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1645
License Number StateIA

VIII. Authorized Official

Name: LESLIE HERRON
Title or Position: PRESIDENT
Credential: RPH
Phone: 360-420-6401