Healthcare Provider Details

I. General information

NPI: 1972679744
Provider Name (Legal Business Name): HEG-JORG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 14TH ST
DALLAS CENTER IA
50063-2075
US

IV. Provider business mailing address

504 14TH ST PO BOX 369
DALLAS CENTER IA
50063-2075
US

V. Phone/Fax

Practice location:
  • Phone: 515-992-3784
  • Fax: 515-992-4067
Mailing address:
  • Phone: 515-992-3784
  • Fax: 515-992-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number874
License Number StateIA

VIII. Authorized Official

Name: MR. STEVEN EDWARD SCHLAFKE
Title or Position: PHARMACY MANAGEROWNER
Credential: RPH
Phone: 515-992-4823