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General NPI Number Information
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NPI Number | 1013182047
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Entity Type | Organization
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Legal Business Name | IOLA PHARMACY INC
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 1408 EAST ST
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City | IOLA
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State | KS
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Zip | 66749-4402
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Country | US
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Telephone | 620-365-6848
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Fax | 620-365-6849
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Provider Business Mailing Address
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Address Line | 109 E MADISON AVE
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City | IOLA
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State | KS
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Zip | 66749-3330
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Country | US
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Telephone | 620-365-3176
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Fax | 620-365-5111
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Authorized Official
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Title or Position | OWNER
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Name | JAMES BAUER
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Credential |
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Telephone | 620-365-9332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 210178
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License Number State | KS
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