MEDICARE: DR. EDINA OMERHODZIC PHARMD

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	183500000X	Pharmacist	24612	IA

General Provider Information

NPI Number	:	1477279800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDINA OMERHODZIC PHARMD

Provider Business Mailing Address
First Line	:	2321 NE LITTLE BEAVER DR
Second Line	:
City	:	GRIMES
State	:	IA
Zip	:	50111-4510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 NE LITTLE BEAVER DR
Second Line	:
City	:	GRIMES
State	:	IA
Zip	:	50111-4510
Country	:	US
Telephone Number	:	515-371-2877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	10/18/2022

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