Provider Demographics
NPI:1013943224
Name:LAKE MILLS PHARMACY INC
Entity Type:Organization
Organization Name:LAKE MILLS PHARMACY INC
Other - Org Name:REDINGER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:REDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:641-592-0141
Mailing Address - Street 1:219 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:IA
Mailing Address - Zip Code:50450-1405
Mailing Address - Country:US
Mailing Address - Phone:641-592-0141
Mailing Address - Fax:641-592-4329
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:IA
Practice Address - Zip Code:50450-1405
Practice Address - Country:US
Practice Address - Phone:641-592-0141
Practice Address - Fax:641-592-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
IA1063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2026180OtherPK
IA0483909Medicaid
MN510857800Medicaid
MN510857800Medicaid
2026180OtherPK