Provider Demographics
NPI:1689695637
Name:ROCKWELL COLLINS PHARMACY
Entity Type:Organization
Organization Name:ROCKWELL COLLINS PHARMACY
Other - Org Name:ROCKWELL COLLINS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:319-295-9365
Mailing Address - Street 1:5070 ROCKWELL DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402
Mailing Address - Country:US
Mailing Address - Phone:319-295-9365
Mailing Address - Fax:319-373-4414
Practice Address - Street 1:5070 ROCKWELL DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-295-9365
Practice Address - Fax:319-373-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8253336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1617452OtherNCPDP PROVIDER IDENTIFICATION NUMBER