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General NPI Number Information
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NPI Number | 1164589123
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Entity Type | Organization
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Legal Business Name | MEDICAL CENTER PHARMACY
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 06/05/2015
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Provider Practice Location Address
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Address Line | 1720 CENTRAL AVE E
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City | HAMPTON
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State | IA
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Zip | 50441-1859
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Country | US
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Telephone | 641-456-4146
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Fax | 641-456-4984
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Provider Business Mailing Address
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Address Line | 1720 CENTRAL AVE E
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City | HAMPTON
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State | IA
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Zip | 50441-1859
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Country | US
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Telephone | 641-456-4146
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Fax | 641-456-4984
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Authorized Official
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Title or Position | PHARMACIST
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Name | TODD WRAGGE
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Credential | PHARM.D.
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Telephone | 641-456-4146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 82
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License Number State | IA
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