Provider Demographics
NPI:1982001913
Name:REGIONAL HEALTH SERVICES OF HOWARD COUNTY
Entity Type:Organization
Organization Name:REGIONAL HEALTH SERVICES OF HOWARD COUNTY
Other - Org Name:CRESCO FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EFO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-547-2022
Mailing Address - Street 1:235 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:IA
Mailing Address - Zip Code:52136-1064
Mailing Address - Country:US
Mailing Address - Phone:563-547-6666
Mailing Address - Fax:563-547-6393
Practice Address - Street 1:235 8TH AVE W
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1062
Practice Address - Country:US
Practice Address - Phone:563-547-6666
Practice Address - Fax:563-547-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA15133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148877OtherPK
IA0706175Medicaid