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General NPI Number Information
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NPI Number | 1801210711
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Entity Type | Organization
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Legal Business Name | C R IV SERVICE INC
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 402 10TH ST SE SUITE 100
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City | CEDAR RAPIDS
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State | IA
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Zip | 52403-2403
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Country | US
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Telephone | 319-247-7200
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Fax | 319-247-7202
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Provider Business Mailing Address
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Address Line | 402 10TH ST SE SUITE 100
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City | CEDAR RAPIDS
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State | IA
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Zip | 52403-2403
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Country | US
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Telephone | 319-247-7200
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Fax | 319-247-7202
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Authorized Official
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Title or Position | CEO
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Name | GARY R. ALBERS
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Credential |
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Telephone | 319-363-4554
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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 | 1102
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License Number State | IA
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