Provider Demographics
NPI:1144732330
Name:KALLENBACH DRUG INC
Entity type:Organization
Organization Name:KALLENBACH DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:563-249-5679
Mailing Address - Street 1:121 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1303
Mailing Address - Country:US
Mailing Address - Phone:563-249-5679
Mailing Address - Fax:
Practice Address - Street 1:111 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-2132
Practice Address - Country:US
Practice Address - Phone:563-249-5679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1617333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy