Healthcare Provider Details

I. General information

NPI: 1285769489
Provider Name (Legal Business Name): PARK PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 6TH ST
SIBLEY IA
51249-1712
US

IV. Provider business mailing address

804 6TH ST
SIBLEY IA
51249-1712
US

V. Phone/Fax

Practice location:
  • Phone: 712-754-3859
  • Fax:
Mailing address:
  • Phone: 712-754-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number418
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number418
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number418
License Number StateIA

VIII. Authorized Official

Name: MR. MICHAEL CLAYTON RAMSDELL
Title or Position: PRESIDENT
Credential: RPH
Phone: 712-754-3859