Healthcare Provider Details

I. General information

NPI: 1992877518
Provider Name (Legal Business Name): BAX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WASHINGTON ST
FONTANELLE IA
50846-9900
US

IV. Provider business mailing address

PO BOX 366 401 WASHINGTON ST
FONTANELLE IA
50846-0366
US

V. Phone/Fax

Practice location:
  • Phone: 641-745-3221
  • Fax: 641-745-3221
Mailing address:
  • Phone:
  • Fax: 641-745-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number654
License Number StateIA

VIII. Authorized Official

Name: KAYE BAX
Title or Position: PRES
Credential: RPH
Phone: 641-745-2008