Provider Demographics
NPI:1710071121
Name:PANORA PHARMACY INC
Entity Type:Organization
Organization Name:PANORA PHARMACY INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:641-755-2312
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-0216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PANORA
Practice Address - State:IA
Practice Address - Zip Code:50216-1097
Practice Address - Country:US
Practice Address - Phone:641-755-2312
Practice Address - Fax:641-755-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA332B00000X
IA189333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0090910Medicaid
1607071OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IAAP5552977OtherDEA #
1607071OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IAAP5552977OtherDEA #