Provider Demographics
NPI:1720006372
Name:MAHASKA DRUG INC
Entity Type:Organization
Organization Name:MAHASKA DRUG INC
Other - Org Name:MAHASKA DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:641-673-3439
Mailing Address - Street 1:205 N E ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2016
Mailing Address - Country:US
Mailing Address - Phone:641-673-3439
Mailing Address - Fax:641-673-3945
Practice Address - Street 1:205 N E ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2016
Practice Address - Country:US
Practice Address - Phone:641-673-3439
Practice Address - Fax:641-673-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4493336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1617402OtherNAPB
IA0097873Medicaid
IA0634580001Medicare NSC