Provider Demographics
NPI:1093036063
Name:FAMILY FHARMACY INC.
Entity Type:Organization
Organization Name:FAMILY FHARMACY INC.
Other - Org Name:LE MARS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:712-546-4481
Mailing Address - Street 1:44 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3536
Mailing Address - Country:US
Mailing Address - Phone:712-546-4560
Mailing Address - Fax:712-546-4575
Practice Address - Street 1:44 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3536
Practice Address - Country:US
Practice Address - Phone:712-546-4560
Practice Address - Fax:712-546-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6594940001Medicare NSC