MEDICARE: DICK PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	108	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1604607	OTHER	IA	NABP

General Provider Information

NPI Number	:	1093713216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DICK PHARMACY, INC.

Provider Business Mailing Address
First Line	:	3024 FOREST AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-2912
Country	:	US
Telephone Number	:	515-255-7676
Fax Number	:

Provider Business Practice Location Address
First Line	:	3024 FOREST AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-2912
Country	:	US
Telephone Number	:	515-255-7676
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAY MEREDITH WANGERIN
Credential	:	R. PH.
Telephone Number	:	515-255-7676

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/22/2020

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Directions to “DICK PHARMACY, INC. ” Practice Location

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