Healthcare Provider Details

I. General information

NPI: 1215742754
Provider Name (Legal Business Name): EAGLE GROVE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W BROADWAY ST
EAGLE GROVE IA
50533-1711
US

IV. Provider business mailing address

PO BOX 331
EAGLE GROVE IA
50533-0331
US

V. Phone/Fax

Practice location:
  • Phone: 515-448-3814
  • Fax: 855-860-9089
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREW J WAGNER
Title or Position: PHARMACY OWNER
Credential:
Phone: 515-448-3814