Provider Demographics
NPI:1508478868
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 1:604 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-1540
Mailing Address - Country:US
Mailing Address - Phone:702-780-9548
Mailing Address - Fax:
Practice Address - Street 1:606 ROSSVILLE RD
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-2228
Practice Address - Country:US
Practice Address - Phone:563-568-0033
Practice Address - Fax:563-568-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0908161Medicaid