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NPI Code Detail

MEDICARE: CORYDON PHARMACY INC

MEDICARE: CORYDON 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
13336C0003XCommunity/Retail Pharmacy595IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31605469OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1336132588
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORYDON PHARMACY INC
Provider Business Mailing Address
First Line : PO BOX 385
Second Line :
City : CORYDON
State : IA
Zip : 50060-0385
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 104 S FRANKLIN ST
Second Line :
City : CORYDON
State : IA
Zip : 50060-1518
Country : US
Telephone Number : 641-872-2512
Fax Number : 641-872-1078
Authorized Official
Title or Position : PRESIDENT AND OWNER
Name : MARK NESSEN
Credential :
Telephone Number : 641-872-2512
Provider Enumeration Date : 08/23/2005
Last Update Date : 02/16/2010

Similar Medicare Providers

1922090752 — CHARLES A CLARK OD
Practice Location Address:
212 N FRANKLIN ST
CORYDON, IA
50060-1328
Practice Phone: 641-774-5819
Practice Fax: 641-774-8415
1114902087 — JOEL ALAN WELLS D.O.
Practice Location Address:
417 S EAST ST , SUITE #100
CORYDON, IA
50060-1860
Practice Phone: 641-872-2063
Practice Fax: 641-872-2070
1417932385 — ERNEST MAYTUM BREES P.A.-C
Practice Location Address:
417 S EAST ST , SUITE #100
CORYDON, IA
50060-1860
Practice Phone: 641-872-2063
Practice Fax: 641-872-2070
1124003009 — AMY LYNN WOOD P.A.-C
Practice Location Address:
417 S EAST ST , SUITE #100
CORYDON, IA
50060-1860
Practice Phone: 641-872-2063
Practice Fax: 641-872-2070
1518943141 — JOEL LEN BAKER DO
Practice Location Address:
417 S. EAST
CORYDON, IA
50060-1860
Practice Phone: 641-872-2063
Practice Fax: 641-872-2070
1275513301 — DOUGLAS W HOCH MD
Practice Location Address:
417 S. EAST ST.
CORYDON, IA
50060-1860
Practice Phone: 641-872-2063
Practice Fax: 641-872-2070

Directions to “CORYDON PHARMACY INC ” Practice Location

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