Provider Demographics
NPI:1013401793
Name:LAGRANGE PHARMACY INC.
Entity Type:Organization
Organization Name:LAGRANGE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:LAGRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-560-9336
Mailing Address - Street 1:111 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-1121
Mailing Address - Country:US
Mailing Address - Phone:319-472-4274
Mailing Address - Fax:
Practice Address - Street 1:111 W 4TH ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-1121
Practice Address - Country:US
Practice Address - Phone:319-472-4274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAGRANGE PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA93336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy