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General NPI Number Information
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NPI Number | 1194818674
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Entity Type | Organization
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Legal Business Name | K D ENTERPRISES CO INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 802 WASHINGTON ST
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City | PELLA
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State | IA
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Zip | 50219-1525
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Country | US
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Telephone | 641-628-1612
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Fax | 641-620-0021
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Provider Business Mailing Address
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Address Line | 802 WASHINGTON ST
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City | PELLA
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State | IA
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Zip | 50219-1525
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Country | US
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Telephone | 641-628-1612
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Fax | 641-620-0021
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Authorized Official
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Title or Position | OWNER
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Name | MR. DONALD JOHN VERSLUYS
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Credential | R.PH.
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Telephone | 641-628-1612
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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 | 217
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License Number State | IA
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