Healthcare Provider Details

I. General information

NPI: 1285629618
Provider Name (Legal Business Name): POCAHONTAS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W ELM AVE
POCAHONTAS IA
50574-1439
US

IV. Provider business mailing address

701 W ELM AVE
POCAHONTAS IA
50574-1439
US

V. Phone/Fax

Practice location:
  • Phone: 712-335-3119
  • Fax: 712-335-4145
Mailing address:
  • Phone: 712-335-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateIA

VIII. Authorized Official

Name: PAT STURTZ
Title or Position: OWNER/PHARMACIST
Credential: R.PH
Phone: 712-335-3119