Healthcare Provider Details

I. General information

NPI: 1720886344
Provider Name (Legal Business Name): STATE UNIVERSITY OF IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E COURT AVE STE 110
DES MOINES IA
50309-2044
US

IV. Provider business mailing address

110 E COURT AVE STE 110
DES MOINES IA
50309-2044
US

V. Phone/Fax

Practice location:
  • Phone: 515-558-6549
  • Fax:
Mailing address:
  • Phone: 515-558-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE M MCKELVEY JR.
Title or Position: SR DIR OF GOV'T REIMBURSEMENT
Credential:
Phone: 319-467-8549