Healthcare Provider Details

I. General information

NPI: 1801729553
Provider Name (Legal Business Name): STATELINE APOTHECARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 REED ST
AKRON IA
51001-7779
US

IV. Provider business mailing address

233 REED ST
AKRON IA
51001-7779
US

V. Phone/Fax

Practice location:
  • Phone: 712-568-2013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRICE WILLIAM BURYANEK
Title or Position: PHARMD
Credential:
Phone: 712-301-2585