Healthcare Provider Details

I. General information

NPI: 1598751489
Provider Name (Legal Business Name): P R HORTON RPH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 APACHE CT
SIOUX CITY IA
51104-1504
US

IV. Provider business mailing address

2609 APACHE CT
SIOUX CITY IA
51104-1504
US

V. Phone/Fax

Practice location:
  • Phone: 712-224-2845
  • Fax: 712-224-2846
Mailing address:
  • Phone: 712-224-2845
  • Fax: 712-224-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number59
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number59
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number59
License Number StateIA

VIII. Authorized Official

Name: MR. PAUL R HORTON
Title or Position: PRESIDENT
Credential: RP
Phone: 712-224-2845