Healthcare Provider Details

I. General information

NPI: 1659461572
Provider Name (Legal Business Name): ALLEN MEMORIAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W DALE ST SUITE 103
WATERLOO IA
50703-1901
US

IV. Provider business mailing address

146 W DALE ST SUITE 103
WATERLOO IA
50703-1901
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3777
  • Fax: 319-235-3134
Mailing address:
  • Phone: 319-235-3777
  • Fax: 319-235-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number950
License Number StateIA

VIII. Authorized Official

Name: AMY BUCKNELL
Title or Position: PIC
Credential: PHARMD
Phone: 319-235-3134