Provider Demographics
NPI:1942337399
Name:LENZ-REICKS PHARMACY INC
Entity Type:Organization
Organization Name:LENZ-REICKS PHARMACY INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:712-469-2214
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MANSON
Mailing Address - State:IA
Mailing Address - Zip Code:50563-0490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1224 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:IA
Practice Address - Zip Code:50563
Practice Address - Country:US
Practice Address - Phone:712-469-2214
Practice Address - Fax:712-469-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA231333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0158899Medicaid
1618923OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1618923OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1618923OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA0158899Medicaid