Provider Demographics
NPI:1356311013
Name:VOGT PHARMACIES INC
Entity Type:Organization
Organization Name:VOGT PHARMACIES INC
Other - Org Name:PETERSON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/AO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-668-1664
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52361-0360
Mailing Address - Country:US
Mailing Address - Phone:319-668-1664
Mailing Address - Fax:319-668-1667
Practice Address - Street 1:514 ELM ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361-0360
Practice Address - Country:US
Practice Address - Phone:319-668-1664
Practice Address - Fax:319-668-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IA16063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176092OtherPK
IA0079657Medicaid