Healthcare Provider Details

I. General information

NPI: 1104385806
Provider Name (Legal Business Name): PCA IOWA RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 NW URBANDALE DR
URBANDALE IA
50322-7910
US

IV. Provider business mailing address

303 N HURSTBOURNE PKWY STE 200
LOUISVILLE KY
40222-5158
US

V. Phone/Fax

Practice location:
  • Phone: 866-579-3181
  • Fax: 502-996-8148
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA PIETROWSKI
Title or Position: EVP, CHIEF LEGAL OFFICER & SECRETAR
Credential:
Phone: 502-412-5847