Provider Demographics
NPI:1164589123
Name:MEDICAL CENTER PHARMACY
Entity Type:Organization
Organization Name:MEDICAL CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WRAGGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:641-456-4146
Mailing Address - Street 1:1720 CENTRAL AVE E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-1859
Mailing Address - Country:US
Mailing Address - Phone:641-456-4146
Mailing Address - Fax:641-456-4984
Practice Address - Street 1:1720 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441-1859
Practice Address - Country:US
Practice Address - Phone:641-456-4146
Practice Address - Fax:641-456-4984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOERNER-WHIPPLE PHARMACIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0263630002OtherMEDICARE
IA0087213Medicaid