Provider Demographics
NPI:1033241583
Name:POMEROY, DAN (RPH)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:POMEROY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:50058-1611
Mailing Address - Country:US
Mailing Address - Phone:712-999-7979
Mailing Address - Fax:
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:50058-1611
Practice Address - Country:US
Practice Address - Phone:712-999-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist