Provider Demographics
NPI:1083158547
Name:PRESCRIPTION SHOPPE, INC.
Entity Type:Organization
Organization Name:PRESCRIPTION SHOPPE, INC.
Other - Org Name:NIGHTINGALE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGHTINGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-780-9548
Mailing Address - Street 1:807 S HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:IA
Mailing Address - Zip Code:52052-9018
Mailing Address - Country:US
Mailing Address - Phone:563-252-1172
Mailing Address - Fax:563-252-3724
Practice Address - Street 1:807 S HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052-9018
Practice Address - Country:US
Practice Address - Phone:563-252-1172
Practice Address - Fax:563-252-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
IA15973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166716OtherPK
IA0709601Medicaid