Healthcare Provider Details

I. General information

NPI: 1407962400
Provider Name (Legal Business Name): HERRALD DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 STORY ST
BOONE IA
50036-3533
US

IV. Provider business mailing address

403 STORY ST
BOONE IA
50036-3533
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-2311
  • Fax: 515-432-8562
Mailing address:
  • Phone: 515-432-2311
  • Fax: 515-432-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number00063
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0219540001
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number0219540001
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number590
License Number StateIA

VIII. Authorized Official

Name: MR. JAMES R CARLSON
Title or Position: OWNER
Credential: RPH
Phone: 515-432-2311