Provider Demographics
NPI:1811580780
Name:MARENGO MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MARENGO MEMORIAL HOSPITAL
Other - Org Name:CMH PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:GOETTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-642-5543
Mailing Address - Street 1:300 W MAY STREET
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IA
Mailing Address - Zip Code:52301
Mailing Address - Country:US
Mailing Address - Phone:319-642-8039
Mailing Address - Fax:319-642-8077
Practice Address - Street 1:300 W MAY STREET
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IA
Practice Address - Zip Code:52301
Practice Address - Country:US
Practice Address - Phone:319-642-8039
Practice Address - Fax:319-642-8077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARENGO MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-11
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy