Healthcare Provider Details

I. General information

NPI: 1366733669
Provider Name (Legal Business Name): KOHLLS PHARMACY & HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST
MALVERN IA
51551-8137
US

IV. Provider business mailing address

401 MAIN ST
MALVERN IA
51551-8137
US

V. Phone/Fax

Practice location:
  • Phone: 402-895-6812
  • Fax: 402-895-7655
Mailing address:
  • Phone: 712-624-9050
  • Fax: 712-624-9042

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 TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID G KOHLL
Title or Position: PRESIDENT
Credential: RPH
Phone: 402-895-6812