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General NPI Number Information
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NPI Number | 1194855569
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Entity Type | Organization
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Legal Business Name | CENTRAL IOWA COMPOUNDING
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 3290 100TH ST
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City | URBANDALE
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State | IA
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Zip | 50322-3879
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Country | US
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Telephone | 515-252-7688
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Fax | 515-252-7705
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Provider Business Mailing Address
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Address Line | 3290 100TH ST
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City | URBANDALE
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State | IA
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Zip | 50322-3879
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Country | US
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Telephone | 515-252-7688
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Fax | 515-252-7705
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MRS. SUSAN HORTON
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Credential | RPH
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Telephone | 515-252-7688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 762
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License Number State | IA
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