Provider Demographics
NPI:1184639726
Name:MILFORD PHARMACY AND GIFTS
Entity Type:Organization
Organization Name:MILFORD PHARMACY AND GIFTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-338-4865
Mailing Address - Street 1:1012 OKLOBOJI AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51351-1375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1012 OKLOBOJI AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351-1375
Practice Address - Country:US
Practice Address - Phone:712-338-4865
Practice Address - Fax:712-338-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0267278Medicaid
1615612OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0165120001Medicare ID - Type Unspecified