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General NPI Number Information
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NPI Number | 1083782569
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Entity Type | Organization
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Legal Business Name | CAMANCHE PHARMACY INC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 818 7TH AVE
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City | CAMANCHE
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State | IA
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Zip | 52730
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Country | US
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Telephone | 563-259-8361
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Fax | 563-259-9208
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Provider Business Mailing Address
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Address Line | 818 7TH AVE
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City | CAMANCHE
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State | IA
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Zip | 52730
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Country | US
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Telephone | 563-259-8361
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Fax | 563-259-9208
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Authorized Official
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Title or Position | OWNER MANAGER
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Name | MR. ROBERT E RICHESON
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Credential | RPH
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Telephone | 563-259-8361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 140
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License Number State | IA
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