Provider Demographics
NPI:1891801627
Name:P.B.R., INC.
Entity Type:Organization
Organization Name:P.B.R., INC.
Other - Org Name:MED-EQUIP PHARMACY #7
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TSCHOPP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:712-728-2165
Mailing Address - Street 1:1310 18TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1150
Mailing Address - Country:US
Mailing Address - Phone:712-336-0318
Mailing Address - Fax:712-336-5742
Practice Address - Street 1:1310 18TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1150
Practice Address - Country:US
Practice Address - Phone:712-336-0318
Practice Address - Fax:712-336-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1183333600000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0285965Medicaid
IA1621285OtherNCPDP
IA1183OtherPHARMACY LICENSE
IABM7838785OtherDEA
IA1621285OtherNCPDP