Healthcare Provider Details

I. General information

NPI: 1972948727
Provider Name (Legal Business Name): ELIZABETH-S PHARMACY ON MAIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 MAIN AVE N
BRITT IA
50423-1657
US

IV. Provider business mailing address

52 MAIN AVE N
BRITT IA
50423-1657
US

V. Phone/Fax

Practice location:
  • Phone: 641-843-3885
  • Fax: 641-843-4197
Mailing address:
  • Phone: 641-843-3885
  • Fax: 641-843-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1458
License Number StateIA

VIII. Authorized Official

Name: ANDREW J WAGNER
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 515-448-3814