Healthcare Provider Details

I. General information

NPI: 1659967578
Provider Name (Legal Business Name): TOTAL DOSE CENTERVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N 13TH ST
CENTERVILLE IA
52544-1707
US

IV. Provider business mailing address

14101 N EASTERN AVE STE A
EDMOND OK
73013-5860
US

V. Phone/Fax

Practice location:
  • Phone: 641-437-7200
  • Fax: 641-437-7300
Mailing address:
  • Phone: 405-562-1800
  • Fax: 405-562-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID GEORGE
Title or Position: CO-OWNER/MANAGER
Credential:
Phone: 405-562-1800