Provider Demographics
NPI:1871687905
Name:GBANK HEALTH LLC
Entity Type:Organization
Organization Name:GBANK HEALTH LLC
Other - Org Name:MT. VERNON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:563-505-3528
Mailing Address - Street 1:101 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:319-895-6348
Mailing Address - Fax:319-895-6991
Practice Address - Street 1:101 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:319-895-6348
Practice Address - Fax:319-895-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA800332B00000X, 3336C0003X
3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1871687905Medicaid
IA08014OtherMEDICARE PART B FLU
IAIB1274Medicare PIN
IA08014OtherMEDICARE PART B FLU