Healthcare Provider Details

I. General information

NPI: 1619990694
Provider Name (Legal Business Name): KASSON DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 6TH ST
ARMSTRONG IA
50514-0666
US

IV. Provider business mailing address

PO BOX 500
ARMSTRONG IA
50514-0500
US

V. Phone/Fax

Practice location:
  • Phone: 712-868-3502
  • Fax: 712-868-3280
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberIA640
License Number StateIA

VIII. Authorized Official

Name: BRENT KASSON
Title or Position: PHARMACIST IN CHARGE OWNER
Credential: RPH
Phone: 712-868-3502