MEDICARE: PHARMA340 LLC

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	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1316406648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMA340 LLC

Provider Business Mailing Address
First Line	:	1321 W MAIN ST
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449-1585
Country	:	US
Telephone Number	:	712-830-5443
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 E LAKE ST
Second Line	:
City	:	ROCKWELL CITY
State	:	IA
Zip	:	50579-1711
Country	:	US
Telephone Number	:	712-297-7337
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	STEVEN DONNELLY
Credential	:
Telephone Number	:	210-441-2036

Provider Enumeration Date	:	03/16/2019
Last Update Date	:	12/17/2024

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