Healthcare Provider Details

I. General information

NPI: 1922091925
Provider Name (Legal Business Name): PHARMACY ASSOCIATES OF CARROLL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HWY 30 WEST, SUITE 140C
CARROLL IA
51401-0157
US

IV. Provider business mailing address

425 HWY 30 WEST, SUITE 140C PO BOX 157
CARROLL IA
51401-0157
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-2671
  • Fax: 712-792-3951
Mailing address:
  • Phone: 712-792-2671
  • Fax: 712-792-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1253
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1253
License Number StateIA

VIII. Authorized Official

Name: PHILLIP J MARKWAY
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 712-792-2671