Provider Demographics
NPI:1194855569
Name:CENTRAL IOWA COMPOUNDING
Entity Type:Organization
Organization Name:CENTRAL IOWA COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-252-7688
Mailing Address - Street 1:3290 100TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3879
Mailing Address - Country:US
Mailing Address - Phone:515-252-7688
Mailing Address - Fax:515-252-7705
Practice Address - Street 1:3290 100TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3879
Practice Address - Country:US
Practice Address - Phone:515-252-7688
Practice Address - Fax:515-252-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7623336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy