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General NPI Number Information
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NPI Number | 1992755615
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Entity Type | Organization
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Legal Business Name | C R PHARMACY SERVICE INC
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 402 10TH ST SE SUITE 600
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City | CEDAR RAPIDS
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State | IA
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Zip | 52403-2459
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Country | US
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Telephone | 319-298-0953
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Fax | 319-298-0954
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Provider Business Mailing Address
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Address Line | 402 10TH ST SE SUITE 600
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City | CEDAR RAPIDS
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State | IA
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Zip | 52403-2459
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Country | US
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Telephone | 319-298-0953
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Fax | 319-298-0954
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Authorized Official
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Title or Position | CEO
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Name | MRS. MICHELLE M. JENSEN
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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 | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 5641
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License Number State | IA
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