Provider Demographics
NPI:1083708499
Name:WHAS RX LLC
Entity Type:Organization
Organization Name:WHAS RX LLC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT WHAS RX LLC
Authorized Official - Prefix:
Authorized Official - First Name:SHERWOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:507-272-6601
Mailing Address - Street 1:516 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-9544
Mailing Address - Country:US
Mailing Address - Phone:641-648-4263
Mailing Address - Fax:641-648-4264
Practice Address - Street 1:516 S OAK ST
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-9544
Practice Address - Country:US
Practice Address - Phone:641-648-4263
Practice Address - Fax:641-648-4264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11723336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134599OtherPK