Provider Demographics
NPI:1922153550
Name:DUMONT PHARMACY
Entity Type:Organization
Organization Name:DUMONT PHARMACY
Other - Org Name:ALLIMONT PHARMACIES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:641-857-3851
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:513 MAIN ST.
Mailing Address - City:DUMONT
Mailing Address - State:IA
Mailing Address - Zip Code:50625-0306
Mailing Address - Country:US
Mailing Address - Phone:641-857-3851
Mailing Address - Fax:
Practice Address - Street 1:513 MAIN ST.
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:IA
Practice Address - Zip Code:50625-0306
Practice Address - Country:US
Practice Address - Phone:641-857-3851
Practice Address - Fax:641-857-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0446400001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0171629Medicaid
IA0171629Medicaid