Provider Demographics
NPI:1689006496
Name:MR PHARMACY LLC
Entity Type:Organization
Organization Name:MR PHARMACY LLC
Other - Org Name:ANKENY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:ROCKFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-289-4008
Mailing Address - Street 1:1325 SW ORALABOR RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8046
Mailing Address - Country:US
Mailing Address - Phone:515-289-4008
Mailing Address - Fax:515-289-2383
Practice Address - Street 1:1325 SW ORALABOR RD
Practice Address - Street 2:STE 200
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8046
Practice Address - Country:US
Practice Address - Phone:515-289-4008
Practice Address - Fax:515-289-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
IA14753336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141512OtherPK
2141512OtherPK