Provider Demographics
NPI:1386861482
Name:AHOY CORP
Entity Type:Organization
Organization Name:AHOY CORP
Other - Org Name:ELDORA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:641-939-3091
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:ELDORA
Mailing Address - State:IA
Mailing Address - Zip Code:50627-0126
Mailing Address - Country:US
Mailing Address - Phone:641-939-3091
Mailing Address - Fax:641-939-3334
Practice Address - Street 1:1274 EDGINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELDORA
Practice Address - State:IA
Practice Address - Zip Code:50627-1739
Practice Address - Country:US
Practice Address - Phone:641-939-3091
Practice Address - Fax:641-939-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BN1400X, 333600000X, 3336L0003X
IA2513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0098228Medicaid
2028880OtherPK
IA0098228Medicaid