Healthcare Provider Details

I. General information

NPI: 1841072311
Provider Name (Legal Business Name): MITCHELL COUNTY PHARMACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 4TH ST STE 3A
SAINT ANSGAR IA
50472-1356
US

IV. Provider business mailing address

PO BOX 309 140 WEST 4TH STREET SUITE 3A
SAINT ANSGAR IA
50472-0309
US

V. Phone/Fax

Practice location:
  • Phone: 641-713-4381
  • Fax:
Mailing address:
  • Phone: 641-713-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GINA GODDARD
Title or Position: TREASURER
Credential:
Phone: 641-732-6086