Provider Demographics
NPI:1568498947
Name:DUTCH MILL CORPORATION
Entity Type:Organization
Organization Name:DUTCH MILL CORPORATION
Other - Org Name:DUTCH MILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:712-737-4844
Mailing Address - Street 1:104 ALBANY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1423
Mailing Address - Country:US
Mailing Address - Phone:712-737-4844
Mailing Address - Fax:712-737-8698
Practice Address - Street 1:104 ALBANY AVE NE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1423
Practice Address - Country:US
Practice Address - Phone:712-737-4844
Practice Address - Fax:712-737-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA4453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2026198OtherPK
IA0048736Medicaid