Healthcare Provider Details

I. General information

NPI: 1447050505
Provider Name (Legal Business Name): KINGSLEY DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W 2ND ST
KINGSLEY IA
51028-7751
US

IV. Provider business mailing address

7 W 2ND ST
KINGSLEY IA
51028-7751
US

V. Phone/Fax

Practice location:
  • Phone: 712-383-3784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CONNOR CLARK
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 712-383-3784