Provider Demographics
NPI:1508972316
Name:P B R INC
Entity Type:Organization
Organization Name:P B R INC
Other - Org Name:MED-EQUIP PHARMACY #0
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TSCHOPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:712-728-2165
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:HARTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51346-0028
Mailing Address - Country:US
Mailing Address - Phone:712-728-2165
Mailing Address - Fax:712-728-2805
Practice Address - Street 1:141 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARTLEY
Practice Address - State:IA
Practice Address - Zip Code:51346-1412
Practice Address - Country:US
Practice Address - Phone:712-728-2165
Practice Address - Fax:712-728-2805
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
IA648333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN797122200Medicaid
IA1603895OtherNCPDP
IA648OtherPHARMACY LICENSE
IA0062695Medicaid
SD8533350Medicaid
SD8533350Medicaid
IAAH4045426OtherDEA