Healthcare Provider Details

I. General information

NPI: 1841236569
Provider Name (Legal Business Name): ROBERT LEE KRUEGER PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S VINE ST
GLENWOOD IA
51534-1927
US

IV. Provider business mailing address

711 S VINE ST
GLENWOOD IA
51534-1927
US

V. Phone/Fax

Practice location:
  • Phone: 712-525-1503
  • Fax: 712-527-2262
Mailing address:
  • Phone: 712-525-1503
  • Fax: 712-527-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15516
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: