Healthcare Provider Details

I. General information

NPI: 1518012814
Provider Name (Legal Business Name): MR PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MAIN ST
CLARION IA
50525-1440
US

IV. Provider business mailing address

210 N MAIN ST
CLARION IA
50525-1440
US

V. Phone/Fax

Practice location:
  • Phone: 515-532-6626
  • Fax: 515-532-3183
Mailing address:
  • Phone: 515-532-6626
  • Fax: 515-532-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number794
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number794
License Number StateIA

VIII. Authorized Official

Name: DR. ROCKFORD CHARLES ANDERSON
Title or Position: OWNER
Credential: PHARM.D.
Phone: 515-532-6626