Provider Demographics
NPI:1891843835
Name:T ZENON PHARMACEUTICALS LLC
Entity Type:Organization
Organization Name:T ZENON PHARMACEUTICALS LLC
Other - Org Name:PHARMACY MATTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:319-337-2492
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-0170
Mailing Address - Country:US
Mailing Address - Phone:319-337-2492
Mailing Address - Fax:319-337-2493
Practice Address - Street 1:1765 LININGER LN
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-2316
Practice Address - Country:US
Practice Address - Phone:319-626-6020
Practice Address - Fax:319-626-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
IA12723336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1622946OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IA0736850Medicaid