Provider Demographics
NPI:1306857818
Name:ANDERSON PHARMACY INC
Entity Type:Organization
Organization Name:ANDERSON PHARMACY INC
Other - Org Name:ANDERSON PHARMACY UNITED DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSRPH
Authorized Official - Phone:563-689-3301
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:52069-0040
Mailing Address - Country:US
Mailing Address - Phone:563-689-3301
Mailing Address - Fax:563-689-3303
Practice Address - Street 1:61 W GILLET ST
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:IA
Practice Address - Zip Code:52069-7709
Practice Address - Country:US
Practice Address - Phone:563-689-3301
Practice Address - Fax:563-689-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IA3073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0126508Medicaid
2027523OtherPK
2027523OtherPK