Healthcare Provider Details

I. General information

NPI: 1356374623
Provider Name (Legal Business Name): FOODS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 HICKMAN RD
CLIVE IA
50325-4326
US

IV. Provider business mailing address

8700 HICKMAN RD
CLIVE IA
50325-4326
US

V. Phone/Fax

Practice location:
  • Phone: 515-276-8784
  • Fax: 515-331-3152
Mailing address:
  • Phone: 515-276-8784
  • Fax: 515-331-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number577
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1604138
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP
# 2
Identifier0076471
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 3
IdentifierI20027
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICARE FLU ROSTER

VIII. Authorized Official

Name: SARAH MORROW
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 515-255-8642