Healthcare Provider Details

I. General information

NPI: 1316968373
Provider Name (Legal Business Name): EAGLE GROVE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W BROADWAY ST
EAGLE GROVE IA
50533-1711
US

IV. Provider business mailing address

311 W BROADWAY ST
EAGLE GROVE IA
50533-1711
US

V. Phone/Fax

Practice location:
  • Phone: 515-448-3814
  • Fax: 515-448-5429
Mailing address:
  • Phone: 515-448-3814
  • Fax: 515-448-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number829
License Number StateIA

VIII. Authorized Official

Name: DR. ANDREW J WAGNER
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 515-448-3814