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General NPI Number Information
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NPI Number | 1811246473
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Entity Type | Organization
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Legal Business Name | STATE UNIVERSITY OF IOWA
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 105 E 9TH STREET SUITE A
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City | CORALVILLE
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State | IA
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Zip | 52241
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Country | US
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Telephone | 319-467-2050
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Fax | 319-467-2070
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Provider Business Mailing Address
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Address Line | 105 E 9TH STREET SUITE A
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City | CORALVILLE
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State | IA
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Zip | 52241
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Country | US
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Telephone | 319-467-2050
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Fax | 319-467-2070
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Authorized Official
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Title or Position | SR DIR OF GOVT REIMBURSEMENT
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Name | JOE M MCKELVEY
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Credential |
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Telephone | 319-467-8549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 1419
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License Number State | IA
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