Healthcare Provider Details

I. General information

NPI: 1225785066
Provider Name (Legal Business Name): SPRING CITY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N WALNUT ST
COLFAX IA
50054-1039
US

IV. Provider business mailing address

304 W 2ND ST
PRAIRIE CITY IA
50228-8578
US

V. Phone/Fax

Practice location:
  • Phone: 515-669-2239
  • Fax:
Mailing address:
  • Phone: 515-669-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier446110
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerNAICS

VIII. Authorized Official

Name: BRAD MICHAEL MAGG
Title or Position: TREASURER
Credential:
Phone: 515-669-2239