Provider Demographics
NPI:1639149990
Name:MONTROSS PHARMACY,INC
Entity type:Organization
Organization Name:MONTROSS PHARMACY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH-MANAGER- PIC
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:JOBST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-758-2174
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:EARLHAM
Mailing Address - State:IA
Mailing Address - Zip Code:50072-0008
Mailing Address - Country:US
Mailing Address - Phone:515-758-2174
Mailing Address - Fax:515-758-2188
Practice Address - Street 1:115 N CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:EARLHAM
Practice Address - State:IA
Practice Address - Zip Code:50072-0008
Practice Address - Country:US
Practice Address - Phone:515-758-2174
Practice Address - Fax:515-758-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1609900OtherNABP
IA0138818Medicaid