Healthcare Provider Details

I. General information

NPI: 1508972316
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 TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number648
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number648
License Number StateIA

VIII. Authorized Official

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