Healthcare Provider Details

I. General information

NPI: 1619952926
Provider Name (Legal Business Name): CATHOLIC HEALTH INITIATIVES-IOWA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 114TH ST SUITE 234
CLIVE IA
50325-7007
US

IV. Provider business mailing address

1601 NW 114TH ST SUITE 234
CLIVE IA
50325-7007
US

V. Phone/Fax

Practice location:
  • Phone: 515-222-7979
  • Fax: 515-222-7976
Mailing address:
  • Phone: 515-222-7979
  • Fax: 515-222-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1193
License Number StateIA

VIII. Authorized Official

Name: KURT ANDERSEN
Title or Position: PRESIDENT
Credential:
Phone: 515-358-9200