Provider Demographics
NPI:1013012251
Name:C R PHARMACY SERVICE INC
Entity Type:Organization
Organization Name:C R PHARMACY SERVICE INC
Other - Org Name:CAREPRO HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-363-4554
Mailing Address - Street 1:202 10TH ST SE STE 117
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2424
Mailing Address - Country:US
Mailing Address - Phone:319-369-9620
Mailing Address - Fax:319-826-3558
Practice Address - Street 1:202 10TH ST SE STE 117
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2424
Practice Address - Country:US
Practice Address - Phone:319-369-9620
Practice Address - Fax:319-263-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IA6983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0087205Medicaid
IAIB1274Medicare PIN
IA0146630003Medicare NSC