Provider Demographics
NPI:1750360186
Name:CENTRAL CITY FAMILY PHARMACY, INC.
Entity type:Organization
Organization Name:CENTRAL CITY FAMILY PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDERSCHEID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:319-438-1988
Mailing Address - Street 1:900 BANK CT
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9477
Mailing Address - Country:US
Mailing Address - Phone:319-849-2799
Mailing Address - Fax:319-849-1536
Practice Address - Street 1:900 BANK CT
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-9477
Practice Address - Country:US
Practice Address - Phone:319-849-2799
Practice Address - Fax:319-849-1536
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL CITY FAMILY PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0176917Medicaid
IA0182740004Medicare NSC