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General NPI Number Information
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NPI Number | 1376619106
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Entity Type | Organization
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Legal Business Name | SUN DRUG VILLAGE SQUARE LTD
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 6105 MERLE HAY RD
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City | JOHNSTON
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State | IA
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Zip | 50131-1224
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Country | US
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Telephone | 515-278-5503
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Fax | 515-254-2242
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Provider Business Mailing Address
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Address Line | 6105 MERLE HAY RD PO BOX 288
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City | JOHNSTON
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State | IA
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Zip | 50131-1224
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Country | US
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Telephone | 515-278-5503
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Fax | 515-254-2242
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN H STRAW
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Credential | R.PH.
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Telephone | 515-278-5503
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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 | 842
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License Number State | IA
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