Healthcare Provider Details

I. General information

NPI: 1831271998
Provider Name (Legal Business Name): LAGRANGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 4TH ST
VINTON IA
52349
US

IV. Provider business mailing address

111 W 4TH ST
VINTON IA
52349-1121
US

V. Phone/Fax

Practice location:
  • Phone: 319-472-4274
  • Fax: 319-472-4266
Mailing address:
  • Phone: 319-472-4274
  • Fax: 319-472-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number9
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9
License Number StateIA

VIII. Authorized Official

Name: DAN ARTHUR LAGRANGE
Title or Position: PRESIDENT
Credential:
Phone: 319-560-9336