Provider Demographics
NPI:1003903212
Name:MERCY FAMILY PHARMACY
Entity Type:Organization
Organization Name:MERCY FAMILY PHARMACY
Other - Org Name:MILLER/PURCELL INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:AHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-589-8980
Mailing Address - Street 1:30311 395TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:IA
Mailing Address - Zip Code:52031-9647
Mailing Address - Country:US
Mailing Address - Phone:563-872-4257
Mailing Address - Fax:563-852-7758
Practice Address - Street 1:805 JOHNSON ST SW
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:IA
Practice Address - Zip Code:52033-8636
Practice Address - Country:US
Practice Address - Phone:563-852-7757
Practice Address - Fax:563-852-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17231183500000X
WI11558-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty