Provider Demographics
NPI:1619982204
Name:PLENCORP
Entity Type:Organization
Organization Name:PLENCORP
Other - Org Name:REMSEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:712-737-4844
Mailing Address - Street 1:111 S WASHINGTON ST
Mailing Address - Street 2:BOX 407
Mailing Address - City:REMSEN
Mailing Address - State:IA
Mailing Address - Zip Code:51050-7701
Mailing Address - Country:US
Mailing Address - Phone:712-786-2093
Mailing Address - Fax:712-786-3299
Practice Address - Street 1:111 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:REMSEN
Practice Address - State:IA
Practice Address - Zip Code:51050-7701
Practice Address - Country:US
Practice Address - Phone:712-786-2093
Practice Address - Fax:712-786-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA7813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2027860OtherPK
IA1048736Medicaid