Provider Demographics
NPI:1396782991
Name:KINNE FAMILY PHARMACY INC
Entity type:Organization
Organization Name:KINNE FAMILY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KINNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:515-432-3460
Mailing Address - Street 1:120 S STORY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4739
Mailing Address - Country:US
Mailing Address - Phone:515-432-3460
Mailing Address - Fax:515-432-7169
Practice Address - Street 1:120 S STORY ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4739
Practice Address - Country:US
Practice Address - Phone:515-432-3460
Practice Address - Fax:515-432-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
IA14733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142371OtherPK
IA1396782991Medicaid
2142371OtherPK