Provider Demographics
NPI:1780778811
Name:GBANK HEALTH LLC
Entity type:Organization
Organization Name:GBANK HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:563-505-3528
Mailing Address - Street 1:124 E 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IA
Mailing Address - Zip Code:52772
Mailing Address - Country:US
Mailing Address - Phone:563-886-2158
Mailing Address - Fax:563-886-1233
Practice Address - Street 1:124 E 5TH STREET
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772
Practice Address - Country:US
Practice Address - Phone:563-886-2158
Practice Address - Fax:563-886-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0003X, 3336C0003X
IA2473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1780778811Medicaid
IA0146630008Medicare NSC
IAIB1274Medicare PIN