Healthcare Provider Details

I. General information

NPI: 1083708499
Provider Name (Legal Business Name): WHAS RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S OAK ST
IOWA FALLS IA
50126-9544
US

IV. Provider business mailing address

516 S OAK ST
IOWA FALLS IA
50126-9544
US

V. Phone/Fax

Practice location:
  • Phone: 641-648-4263
  • Fax: 641-648-4264
Mailing address:
  • Phone: 641-648-4263
  • Fax: 641-648-4264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1172
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHERWOOD PETERSON
Title or Position: PRESIDENT WHAS RX LLC
Credential: RPH
Phone: 507-272-6601