Provider Demographics
NPI:1194816546
Name:KINNE FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:KINNE FAMILY PHARMACY INC
Other - Org Name:CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KINNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:515-432-3460
Mailing Address - Street 1:1115 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-5304
Mailing Address - Country:US
Mailing Address - Phone:515-432-7123
Mailing Address - Fax:515-432-7088
Practice Address - Street 1:1115 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-5304
Practice Address - Country:US
Practice Address - Phone:515-432-7123
Practice Address - Fax:515-432-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IA14743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1194816546Medicaid
2142370OtherPK