Provider Demographics
NPI:1558782110
Name:C R PHARMACY SERVICE INC
Entity Type:Organization
Organization Name:C R PHARMACY SERVICE INC
Other - Org Name:KELLY'S HOME MEDICAL, A CAREPRO AFFILIATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-363-4554
Mailing Address - Street 1:931 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5072
Mailing Address - Country:US
Mailing Address - Phone:563-242-2305
Mailing Address - Fax:563-242-4212
Practice Address - Street 1:931 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5072
Practice Address - Country:US
Practice Address - Phone:563-242-2305
Practice Address - Fax:563-242-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies