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General NPI Number Information
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NPI Number | 1609149749
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Entity Type | Organization
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Legal Business Name | KALLENBACH DRUG INC
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 111 S FRANKLIN ST
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City | MANCHESTER
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State | IA
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Zip | 52057
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Country | US
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Telephone | 563-927-4755
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Fax | 563-927-4110
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Provider Business Mailing Address
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Address Line | PO BOX 99
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City | MANCHESTER
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State | IA
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Zip | 52057-0099
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Country | US
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Telephone | 563-927-4755
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Fax | 563-927-4110
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Authorized Official
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Title or Position | OWNER- PHARMACIST IN CHARGE
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Name | DR. JONATHAN KALLENBACH
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Credential | PHARM D
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Telephone | 563-927-4463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 188
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License Number State | IA
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