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General NPI Number Information
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NPI Number | 1164593398
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Entity Type | Organization
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Legal Business Name | FAMILY PHARMACY
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 805 W PLATT ST
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City | MAQUOKETA
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State | IA
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Zip | 52060-2071
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Country | US
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Telephone | 563-652-2511
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Fax | 563-652-1874
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Provider Business Mailing Address
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Address Line | 805 W PLATT ST
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City | MAQUOKETA
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State | IA
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Zip | 52060-2071
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Country | US
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Telephone | 563-652-2511
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Fax | 563-652-1874
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DALE RICHARD YODER
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Credential | RPH
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Telephone | 563-652-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 668
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License Number State | IA
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