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General NPI Number Information
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NPI Number | 1225149628
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Entity Type | Organization
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Legal Business Name | MERCY HEALTH SERVICES-IOWA CORP.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 116 E 11TH ST
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City | SPENCER
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State | IA
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Zip | 51301-4364
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Country | US
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Telephone | 712-262-2343
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Fax | 712-262-1716
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Provider Business Mailing Address
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Address Line | 116 E 11TH ST
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City | SPENCER
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State | IA
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Zip | 51301-4364
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Country | US
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Telephone | 712-262-2343
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Fax | 712-262-1716
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Authorized Official
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Title or Position | MANAGER
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Name | LEMAN OLSON
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Credential |
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Telephone | 641-422-7917
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 620
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License Number State | IA
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