Provider Demographics
NPI:1457486409
Name:PRESCRIPTION SHOPPE INC
Entity Type:Organization
Organization Name:PRESCRIPTION SHOPPE INC
Other - Org Name:NIGHTINGALE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGHTINGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-780-9548
Mailing Address - Street 1:303 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1190
Mailing Address - Country:US
Mailing Address - Phone:319-462-3306
Mailing Address - Fax:319-462-6065
Practice Address - Street 1:303 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205
Practice Address - Country:US
Practice Address - Phone:319-462-3306
Practice Address - Fax:319-462-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
IA763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143891OtherPK
IA0112234Medicaid
IA0026864Medicaid
IA76OtherSTATE PHARMACY LICENSE
IA0271360001Medicare NSC