Provider Demographics
NPI:1376615310
Name:IOLA PHARMACY INC.
Entity Type:Organization
Organization Name:IOLA PHARMACY INC.
Other - Org Name:IOLA PHARMACY RESPIRATORY & MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIEKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-365-3377
Mailing Address - Street 1:107 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-3330
Mailing Address - Country:US
Mailing Address - Phone:620-365-3377
Mailing Address - Fax:
Practice Address - Street 1:107 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3330
Practice Address - Country:US
Practice Address - Phone:620-365-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11211332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0227660002Medicare NSC