Provider Demographics
NPI:1336213859
Name:DUTCHMEN INCORPORATED
Entity Type:Organization
Organization Name:DUTCHMEN INCORPORATED
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:641-342-6557
Mailing Address - Street 1:214 S. MAIN
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213
Mailing Address - Country:US
Mailing Address - Phone:641-342-6557
Mailing Address - Fax:641-342-6558
Practice Address - Street 1:214 S. MAIN
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213
Practice Address - Country:US
Practice Address - Phone:641-342-6557
Practice Address - Fax:641-342-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5023336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0006528Medicaid
IA1612438OtherNABP
IA1612438OtherNABP
IA1612438OtherNABP