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General NPI Number Information
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NPI Number | 1912902024
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Entity Type | Organization
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Legal Business Name | CC ANDERSON PC
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 411 ANNEX RD
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City | MADRID
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State | IA
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Zip | 50156-1471
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Country | US
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Telephone | 515-795-4252
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Fax | 515-795-4255
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Provider Business Mailing Address
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Address Line | 411 ANNEX RD
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City | MADRID
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State | IA
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Zip | 50156-1471
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE M ANDERSON
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Credential | RPH
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Telephone | 515-795-4252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 274
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License Number State | IA
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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 |
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License Number State |
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