Healthcare Provider Details

I. General information

NPI: 1912068644
Provider Name (Legal Business Name): FAR BIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 S B AVE
NEVADA IA
50201-2804
US

IV. Provider business mailing address

1727 S B AVE
NEVADA IA
50201-2804
US

V. Phone/Fax

Practice location:
  • Phone: 515-382-2134
  • Fax: 515-382-2346
Mailing address:
  • Phone: 515-382-2134
  • Fax: 515-382-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number333
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0135327
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier2029352
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: PETER BILDEN
Title or Position: OWNER
Credential: RPH
Phone: 515-382-2134