Healthcare Provider Details

I. General information

NPI: 1578639407
Provider Name (Legal Business Name): DLA RX SUNDRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAIN ST
MC GREGOR IA
52157-8774
US

IV. Provider business mailing address

PO BOX 468
MC GREGOR IA
52157-0468
US

V. Phone/Fax

Practice location:
  • Phone: 563-873-3781
  • Fax: 563-873-1635
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1453
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2140383
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: DENNIS ALCORN
Title or Position: PRESIDENT
Credential:
Phone: 563-873-3781