Provider Demographics
NPI:1407876204
Name:PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:PHARMACY SERVICES, INC.
Other - Org Name:LUTZ PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-967-4213
Mailing Address - Street 1:120 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1950
Mailing Address - Country:US
Mailing Address - Phone:515-967-4213
Mailing Address - Fax:515-967-3402
Practice Address - Street 1:120 8TH ST SE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1950
Practice Address - Country:US
Practice Address - Phone:515-967-4213
Practice Address - Fax:515-967-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA403336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1604568OtherNCPDP NUMBER
IA1407876204Medicaid
IA40OtherPHARMACY LICENSE NUMBER
IA40OtherPHARMACY LICENSE NUMBER
IA1407876204Medicaid