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General NPI Number Information
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NPI Number | 1639149990
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Entity Type | Organization
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Legal Business Name | MONTROSS PHARMACY,INC
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 115 N CHESTNUT AVE
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City | EARLHAM
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State | IA
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Zip | 50072-0008
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Country | US
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Telephone | 515-758-2174
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Fax | 515-758-2188
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Provider Business Mailing Address
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Address Line | PO BOX 8
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City | EARLHAM
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State | IA
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Zip | 50072-0008
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Country | US
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Telephone | 515-758-2174
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Fax | 515-758-2188
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Authorized Official
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Title or Position | RPH-MANAGER- PIC
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Name | MARK GLENN JOBST
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Credential | RPH
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Telephone | 515-758-2174
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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 | 104
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License Number State | IA
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