Provider Demographics
NPI:1376642835
Name:LETSCHE APOTHECARY
Entity Type:Organization
Organization Name:LETSCHE APOTHECARY
Other - Org Name:MAIN STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LETSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-368-4549
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:HOLSTEIN
Mailing Address - State:IA
Mailing Address - Zip Code:51025-0070
Mailing Address - Country:US
Mailing Address - Phone:712-368-4549
Mailing Address - Fax:712-368-2124
Practice Address - Street 1:103 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLSTEIN
Practice Address - State:IA
Practice Address - Zip Code:51025
Practice Address - Country:US
Practice Address - Phone:712-368-4549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0278820Medicaid
IA0278820Medicaid