MEDICARE: SAC CITY DRUG, 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	183500000X	Pharmacist	18471	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

General Provider Information

NPI Number	:	1982685525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAC CITY DRUG, LLC.

Provider Business Mailing Address
First Line	:	514 W MAIN ST
Second Line	:
City	:	SAC CITY
State	:	IA
Zip	:	50583
Country	:	US
Telephone Number	:	712-662-7146
Fax Number	:	712-662-3226

Provider Business Practice Location Address
First Line	:	514 W MAIN ST
Second Line	:
City	:	SAC CITY
State	:	IA
Zip	:	50583
Country	:	US
Telephone Number	:	712-662-7146
Fax Number	:	712-662-3226

Authorized Official
Title or Position	:	PHARMACIST
Name	:	JENNA MANN
Credential	:	PHARMD
Telephone Number	:	712-662-7146

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	02/10/2014

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