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General NPI Number Information
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NPI Number | 1821189366
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Entity Type | Organization
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Legal Business Name | EBY DRUG STORE (LOGAN), INC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 103 N 4TH AVE
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City | LOGAN
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State | IA
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Zip | 51546
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Country | US
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Telephone | 712-644-2160
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Fax | 712-644-2103
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Provider Business Mailing Address
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Address Line | 103 N 4TH AVE P.O. BOX 187
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City | LOGAN
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State | IA
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Zip | 51546
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Country | US
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Telephone | 712-644-2160
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Fax | 712-644-2103
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN P. EBY
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Credential |
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Telephone | 712-644-2848
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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 | 603
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License Number State | IA
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