Healthcare Provider Details

I. General information

NPI: 1184786113
Provider Name (Legal Business Name): KOERNER-WHIPPLE PHARMACIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 1ST ST NW
HAMPTON IA
50441
US

IV. Provider business mailing address

104 1ST ST NW
HAMPTON IA
50441-1702
US

V. Phone/Fax

Practice location:
  • Phone: 641-456-2510
  • Fax: 641-456-4984
Mailing address:
  • Phone: 641-456-2510
  • Fax: 641-456-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number682
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TODD WRAGGE
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 641-456-2510