Healthcare Provider Details

I. General information

NPI: 1720006372
Provider Name (Legal Business Name): MAHASKA DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N E ST
OSKALOOSA IA
52577-2016
US

IV. Provider business mailing address

205 N E ST
OSKALOOSA IA
52577-2016
US

V. Phone/Fax

Practice location:
  • Phone: 641-673-3439
  • Fax: 641-673-3945
Mailing address:
  • Phone: 641-673-3439
  • Fax: 641-673-3945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number449
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MISS JANE M NICHOLSON
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 641-673-3439