Provider Demographics
NPI:1346376530
Name:BLOEMKE PHARMACY
Entity Type:Organization
Organization Name:BLOEMKE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:641-444-3451
Mailing Address - Street 1:443 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELMOND
Mailing Address - State:IA
Mailing Address - Zip Code:50421-1223
Mailing Address - Country:US
Mailing Address - Phone:641-444-3451
Mailing Address - Fax:641-444-7047
Practice Address - Street 1:443 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELMOND
Practice Address - State:IA
Practice Address - Zip Code:50421-1223
Practice Address - Country:US
Practice Address - Phone:641-444-3451
Practice Address - Fax:641-444-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6323336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0295140001Medicare ID - Type Unspecified