Provider Demographics
NPI:1558354688
Name:CARROLL APOTHECARY, INC
Entity Type:Organization
Organization Name:CARROLL APOTHECARY, INC
Other - Org Name:HOME CARE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRLBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-792-4591
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-0157
Mailing Address - Country:US
Mailing Address - Phone:712-792-4591
Mailing Address - Fax:712-792-0894
Practice Address - Street 1:425 HIGHWAY 30 WEST
Practice Address - Street 2:SUITE 140
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-0157
Practice Address - Country:US
Practice Address - Phone:712-792-4591
Practice Address - Fax:712-792-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 332B00000X
IA332BP3500X
IA3573336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0089276Medicaid
IA0187963OtherMEDICAID WAIVER PROVIDER
IA09897OtherWELLMARK BC/BS
IA0089276Medicaid