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General NPI Number Information
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NPI Number | 1093713216
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Entity Type | Organization
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Legal Business Name | DICK PHARMACY, INC.
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3024 FOREST AVE
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City | DES MOINES
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State | IA
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Zip | 50311-2912
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Country | US
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Telephone | 515-255-7676
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Fax |
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Provider Business Mailing Address
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Address Line | 3024 FOREST AVE
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City | DES MOINES
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State | IA
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Zip | 50311-2912
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Country | US
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Telephone | 515-255-7676
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAY MEREDITH WANGERIN
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Credential | R. PH.
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Telephone | 515-255-7676
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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 | 108
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License Number State | IA
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