Provider Demographics
NPI:1720406598
Name:CR PHARMACY SERVICE, INC
Entity Type:Organization
Organization Name:CR PHARMACY SERVICE, INC
Other - Org Name:CAREPRO PHARMACY - MT VERNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-363-4554
Mailing Address - Street 1:113 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1422
Mailing Address - Country:US
Mailing Address - Phone:319-895-6248
Mailing Address - Fax:319-895-6991
Practice Address - Street 1:113 1ST ST NE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1422
Practice Address - Country:US
Practice Address - Phone:319-895-6248
Practice Address - Fax:319-895-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy