Healthcare Provider Details

I. General information

NPI: 1871142182
Provider Name (Legal Business Name): MEGAN ELIZABETH MANDERSCHEID PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E MAIN ST
CENTRAL CITY IA
52214-9454
US

IV. Provider business mailing address

402 E MAIN ST
CENTRAL CITY IA
52214-9454
US

V. Phone/Fax

Practice location:
  • Phone: 319-438-1988
  • Fax: 319-438-1094
Mailing address:
  • Phone: 319-438-1988
  • Fax: 319-438-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20861
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: