Healthcare Provider Details

I. General information

NPI: 1235245051
Provider Name (Legal Business Name): P B R INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 S CENTRAL AVE
HARTLEY IA
51346-1412
US

IV. Provider business mailing address

PO BOX 28
HARTLEY IA
51346-0028
US

V. Phone/Fax

Practice location:
  • Phone: 712-728-2165
  • Fax: 712-728-2805
Mailing address:
  • Phone: 712-728-2165
  • Fax: 712-728-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number1107
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number2613819
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1107
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2613819
License Number StateMN

VIII. Authorized Official

Name: MR. WALLY J. TSCHOPP
Title or Position: OWNER
Credential: RPH
Phone: 712-728-2165