Healthcare Provider Details

I. General information

NPI: 1285921494
Provider Name (Legal Business Name): KOHLL'S PHARMACY & HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MAIN ST
MALVERN IA
51551-8033
US

IV. Provider business mailing address

410 MAIN ST
MALVERN IA
51551-8033
US

V. Phone/Fax

Practice location:
  • Phone: 712-624-9050
  • Fax: 712-624-9042
Mailing address:
  • Phone: 712-624-9050
  • Fax: 712-624-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID G KOHLL
Title or Position: OWNER
Credential: RPH
Phone: 402-895-6812