Healthcare Provider Details

I. General information

NPI: 1013182047
Provider Name (Legal Business Name): IOLA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 EAST ST
IOLA KS
66749-4402
US

IV. Provider business mailing address

109 E MADISON AVE
IOLA KS
66749-3330
US

V. Phone/Fax

Practice location:
  • Phone: 620-365-6848
  • Fax: 620-365-6849
Mailing address:
  • Phone: 620-365-3176
  • Fax: 620-365-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number210178
License Number StateKS

VIII. Authorized Official

Name: JAMES BAUER
Title or Position: OWNER
Credential:
Phone: 620-365-9332