Provider Demographics
NPI:1578639407
Name:DLA RX SUNDRY INC
Entity Type:Organization
Organization Name:DLA RX SUNDRY INC
Other - Org Name:MCGREGOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-873-3781
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:IA
Mailing Address - Zip Code:52157-0468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:IA
Practice Address - Zip Code:52157-8774
Practice Address - Country:US
Practice Address - Phone:563-873-3781
Practice Address - Fax:563-873-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140383OtherPK