Provider Demographics
NPI:1093750416
Name:ESTHERVILLE DRUG COMPANY INC
Entity Type:Organization
Organization Name:ESTHERVILLE DRUG COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:712-362-3154
Mailing Address - Street 1:522 CENTRAL AVE
Mailing Address - Street 2:BOX 388
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-2239
Mailing Address - Country:US
Mailing Address - Phone:712-362-3154
Mailing Address - Fax:712-362-7770
Practice Address - Street 1:522 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2239
Practice Address - Country:US
Practice Address - Phone:712-362-3154
Practice Address - Fax:712-362-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 332BX2000X
IA7333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0017517Medicaid
0178380001Medicare ID - Type UnspecifiedMEDICARE