Provider Demographics
NPI:1033787445
Name:PELLA REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:PELLA REGIONAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RETAIL PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:BREEMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:641-628-1612
Mailing Address - Street 1:404 E 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50228
Mailing Address - Country:US
Mailing Address - Phone:515-994-2618
Mailing Address - Fax:515-994-3013
Practice Address - Street 1:404 E 2ND STREET
Practice Address - Street 2:
Practice Address - City:PRAIRIE CITY
Practice Address - State:IA
Practice Address - Zip Code:50228
Practice Address - Country:US
Practice Address - Phone:515-994-2618
Practice Address - Fax:515-994-3013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PELLA REGIONAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies