Healthcare Provider Details

I. General information

NPI: 1306915400
Provider Name (Legal Business Name): FREDERICK C & ANN M MARCALUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 MAIN ST
JEWELL IA
50130-0070
US

IV. Provider business mailing address

633 MAIN ST PO BOX 70
JEWELL IA
50130-0070
US

V. Phone/Fax

Practice location:
  • Phone: 515-827-5134
  • Fax: 515-827-5776
Mailing address:
  • Phone: 515-827-5134
  • Fax: 515-827-5776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number99
License Number StateIA

VIII. Authorized Official

Name: ANN MARCALUS
Title or Position: PHARMACIST
Credential:
Phone: 515-827-5134