Healthcare Provider Details

I. General information

NPI: 1356435762
Provider Name (Legal Business Name): PHILL MONT COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 16TH ST
CLARINDA IA
51632-2107
US

IV. Provider business mailing address

201 S 16TH ST
CLARINDA IA
51632-2107
US

V. Phone/Fax

Practice location:
  • Phone: 712-542-6546
  • Fax: 712-542-4955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number310
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN MOWERY
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 712-542-6546