Healthcare Provider Details

I. General information

NPI: 1013943224
Provider Name (Legal Business Name): LAKE MILLS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W MAIN ST
LAKE MILLS IA
50450-1405
US

IV. Provider business mailing address

219 W MAIN ST
LAKE MILLS IA
50450-1405
US

V. Phone/Fax

Practice location:
  • Phone: 641-592-0141
  • Fax: 641-592-4329
Mailing address:
  • Phone: 641-592-0141
  • Fax: 641-592-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number106
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AARON REDINGER
Title or Position: MANAGER
Credential: RPH
Phone: 641-592-0141