Healthcare Provider Details

I. General information

NPI: 1700808789
Provider Name (Legal Business Name): LARCAM PHARMACY LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 10TH AVE N BOX 384
HUMBOLDT IA
50548-1112
US

IV. Provider business mailing address

1310 10TH AVE N
HUMBOLDT IA
50548-1112
US

V. Phone/Fax

Practice location:
  • Phone: 515-332-1627
  • Fax: 515-332-4324
Mailing address:
  • Phone: 515-332-1627
  • Fax: 515-332-4324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number630
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CARLEEN ANN MILEWSKI
Title or Position: OWNER
Credential:
Phone: 515-332-1627