Provider Demographics
NPI:1013900018
Name:PHARMACY ASSOCIATES OF CARROLL,INC
Entity Type:Organization
Organization Name:PHARMACY ASSOCIATES OF CARROLL,INC
Other - Org Name:CARROLL CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGEBART
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:712-792-3212
Mailing Address - Street 1:405 S CLARK ST STE 150
Mailing Address - Street 2:PO BOX 157
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3066
Mailing Address - Country:US
Mailing Address - Phone:712-792-3212
Mailing Address - Fax:712-792-0160
Practice Address - Street 1:405 S CLARK ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3065
Practice Address - Country:US
Practice Address - Phone:712-792-3212
Practice Address - Fax:712-792-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA353333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0118034Medicaid
IA0118034Medicaid