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General NPI Number Information
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NPI Number | 1891801627
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Entity Type | Organization
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Legal Business Name | P.B.R., INC.
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1310 18TH ST SUITE B
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City | SPIRIT LAKE
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State | IA
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Zip | 51360-1150
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Country | US
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Telephone | 712-336-0318
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Fax | 712-336-5742
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Provider Business Mailing Address
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Address Line | 1310 18TH ST SUITE B
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City | SPIRIT LAKE
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State | IA
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Zip | 51360-1150
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Country | US
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Telephone | 712-336-0318
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Fax | 712-336-5742
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WALLY J. TSCHOPP
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Credential | RPH
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Telephone | 712-728-2165
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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 | 1183
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 1183
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 1183
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License Number State | IA
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