Provider Demographics
NPI:1306825179
Name:TOWNCREST PHARMACY CORP.
Entity Type:Organization
Organization Name:TOWNCREST PHARMACY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DENINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-337-3526
Mailing Address - Street 1:2306 MUSCATINE AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6637
Mailing Address - Country:US
Mailing Address - Phone:319-337-3526
Mailing Address - Fax:319-337-5271
Practice Address - Street 1:2306 MUSCATINE AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6637
Practice Address - Country:US
Practice Address - Phone:319-337-3526
Practice Address - Fax:319-337-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA838183500000X
332B00000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00681061Medicaid
IA00681061Medicaid