MEDICARE: MONTROSS 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
2	3336C0003X	Community/Retail Pharmacy	111	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2026849	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740370667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTROSS PHARMACY INC

Provider Business Mailing Address
First Line	:	134 W MAIN ST
Second Line	:
City	:	SAINT CHARLES
State	:	IA
Zip	:	50240-7701
Country	:	US
Telephone Number	:	641-396-2445
Fax Number	:	641-396-2830

Provider Business Practice Location Address
First Line	:	134 W MAIN ST
Second Line	:
City	:	SAINT CHARLES
State	:	IA
Zip	:	50240-7701
Country	:	US
Telephone Number	:	641-396-2445
Fax Number	:	641-396-2830

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFF OLSON
Credential	:
Telephone Number	:	515-462-2282

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	12/01/2016

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Directions to “MONTROSS PHARMACY INC ” Practice Location

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