Healthcare Provider Details

I. General information

NPI: 1558354688
Provider Name (Legal Business Name): CARROLL APOTHECARY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HIGHWAY 30 WEST SUITE 140
CARROLL IA
51401-0157
US

IV. Provider business mailing address

PO BOX 157
CARROLL IA
51401-0157
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-4591
  • Fax: 712-792-0894
Mailing address:
  • Phone: 712-792-4591
  • Fax: 712-792-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number357
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TERESA IRLBECK
Title or Position: MANAGER
Credential:
Phone: 712-792-4591