Provider Demographics
NPI:1720231954
Name:REDINGER PHARMACY, LLC
Entity Type:Organization
Organization Name:REDINGER PHARMACY, LLC
Other - Org Name:REDINGER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:REDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-592-0141
Mailing Address - Street 1:219 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:IA
Mailing Address - Zip Code:50450-1405
Mailing Address - Country:US
Mailing Address - Phone:641-592-0141
Mailing Address - Fax:641-592-4329
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:IA
Practice Address - Zip Code:50450-1405
Practice Address - Country:US
Practice Address - Phone:641-592-0141
Practice Address - Fax:641-592-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4155100001Medicare NSC