Provider Demographics
NPI:1245325901
Name:GARDNER DRUG INC
Entity type:Organization
Organization Name:GARDNER DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-394-4131
Mailing Address - Street 1:15 E MAIN ST
Mailing Address - Street 2:PO BOX 309
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-2115
Mailing Address - Country:US
Mailing Address - Phone:641-394-4131
Mailing Address - Fax:641-394-4599
Practice Address - Street 1:15 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-2115
Practice Address - Country:US
Practice Address - Phone:641-394-4131
Practice Address - Fax:641-394-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0011130Medicaid
IA0180960001Medicare NSC