Provider Demographics
NPI:1952312464
Name:BANCROFT PHCY AND HM HEALTH CARE
Entity Type:Organization
Organization Name:BANCROFT PHCY AND HM HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH PHARMD
Authorized Official - Phone:515-885-2764
Mailing Address - Street 1:PO BOX 318
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:IA
Mailing Address - Zip Code:50517-0318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANCROFT
Practice Address - State:IA
Practice Address - Zip Code:50517-8073
Practice Address - Country:US
Practice Address - Phone:515-885-2764
Practice Address - Fax:515-885-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA735333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1600091OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA0175034Medicaid
IA0175034Medicaid