Healthcare Provider Details

I. General information

NPI: 1417923061
Provider Name (Legal Business Name): GUTTENBERG PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 S HIGHWAY 52
GUTTENBERG IA
52052-0280
US

IV. Provider business mailing address

807 S HIGHWAY 52 PO BOX 280
GUTTENBERG IA
52052-0280
US

V. Phone/Fax

Practice location:
  • Phone: 563-252-1172
  • Fax: 563-252-3724
Mailing address:
  • Phone: 563-252-1172
  • Fax: 563-252-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5
License Number StateIA

VIII. Authorized Official

Name: MR. DANIEL J SHANNON
Title or Position: PRESIDENT
Credential: RPH
Phone: 563-252-1172