Provider Demographics
NPI:1063491488
Name:CENTRAL CITY FAMILY PHARMACY, INC
Entity Type:Organization
Organization Name:CENTRAL CITY FAMILY PHARMACY, INC
Other - Org Name:ATKINS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDERSCHEID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:319-438-1988
Mailing Address - Street 1:401 CARDINAL AVE
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:IA
Mailing Address - Zip Code:52206-4701
Mailing Address - Country:US
Mailing Address - Phone:319-446-6231
Mailing Address - Fax:319-446-3232
Practice Address - Street 1:401 CARDINAL AVE
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:IA
Practice Address - Zip Code:52206-4701
Practice Address - Country:US
Practice Address - Phone:319-446-6231
Practice Address - Fax:319-446-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0140756Medicaid
IA0140756Medicaid