Healthcare Provider Details

I. General information

NPI: 1689631764
Provider Name (Legal Business Name): EASTER ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E MAIN
CLARINDA IA
51632
US

IV. Provider business mailing address

209 E MAIN
CLARINDA IA
51632
US

V. Phone/Fax

Practice location:
  • Phone: 712-542-3814
  • Fax: 712-542-2748
Mailing address:
  • Phone: 712-542-3814
  • Fax: 712-542-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number66
License Number StateIA

VIII. Authorized Official

Name: MRS. VALERIE SUE BAIR
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 712-542-3814