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General NPI Number Information
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NPI Number | 1720006372
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Entity Type | Organization
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Legal Business Name | MAHASKA DRUG INC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 205 N E ST
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City | OSKALOOSA
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State | IA
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Zip | 52577-2016
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Country | US
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Telephone | 641-673-3439
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Fax | 641-673-3945
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Provider Business Mailing Address
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Address Line | 205 N E ST
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City | OSKALOOSA
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State | IA
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Zip | 52577-2016
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Country | US
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Telephone | 641-673-3439
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Fax | 641-673-3945
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MISS JANE M NICHOLSON
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Credential | RPH
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Telephone | 641-673-3439
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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 |
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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 | 449
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License Number State | IA
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