Healthcare Provider Details

I. General information

NPI: 1710071121
Provider Name (Legal Business Name): PANORA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E MAIN ST
PANORA IA
50216-1097
US

IV. Provider business mailing address

PO BOX 216
PANORA IA
50216-0216
US

V. Phone/Fax

Practice location:
  • Phone: 641-755-2312
  • Fax: 641-755-3773
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number189
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA RANDEL
Title or Position: PHARMACIST
Credential: RPH
Phone: 641-755-2312