Provider Demographics
NPI:1407962400
Name:HERRALD DRUG INC
Entity Type:Organization
Organization Name:HERRALD DRUG INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-432-2311
Mailing Address - Street 1:403 STORY ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-3533
Mailing Address - Country:US
Mailing Address - Phone:515-432-2311
Mailing Address - Fax:515-432-8562
Practice Address - Street 1:403 STORY ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-3533
Practice Address - Country:US
Practice Address - Phone:515-432-2311
Practice Address - Fax:515-432-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0219540001332B00000X, 335E00000X
IA00063332S00000X
IA5903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0006247Medicaid
IA1604479OtherNCPDP #
IA1604479OtherNCPDP #
IABH5162336OtherDEA #
IA0219540001Medicare NSC