Provider Demographics
NPI:1316002744
Name:MEDICAP PHARMACY-URBANDALE-FORBES PHARMACY INC
Entity Type:Organization
Organization Name:MEDICAP PHARMACY-URBANDALE-FORBES PHARMACY INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-440-1270
Mailing Address - Street 1:8170 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2411
Mailing Address - Country:US
Mailing Address - Phone:515-276-3471
Mailing Address - Fax:515-276-7482
Practice Address - Street 1:8170 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2411
Practice Address - Country:US
Practice Address - Phone:515-276-3471
Practice Address - Fax:515-276-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5063336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2026894OtherPK
IA0135830Medicaid
I8418Medicare PIN
2026894OtherPK
P00180693Medicare PIN
IAI8418Medicare PIN