Healthcare Provider Details

I. General information

NPI: 1912950239
Provider Name (Legal Business Name): MERCY HOME INFUSION PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 4TH ST SW
MASON CITY IA
50401
US

IV. Provider business mailing address

1000 4TH ST SW
MASON CITY IA
50401
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-5732
  • Fax: 641-428-7431
Mailing address:
  • Phone: 641-428-5732
  • Fax: 641-428-7431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number1369
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ABBY E BAUMAN
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 641-428-5732