Provider Demographics
NPI:1598837387
Name:KRASKO ENTERPRISES INC
Entity Type:Organization
Organization Name:KRASKO ENTERPRISES INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GERE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASKO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:319-283-2028
Mailing Address - Street 1:443 S FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-2504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:443 S FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2504
Practice Address - Country:US
Practice Address - Phone:319-283-2028
Practice Address - Fax:319-283-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IA5353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0167130Medicaid
1611830OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1611830OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA0699440001Medicare NSC