Provider Demographics
NPI:1801881123
Name:COLLEGE HILL DRUG CO.
Entity type:Organization
Organization Name:COLLEGE HILL DRUG CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TAIBER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:319-352-3120
Mailing Address - Street 1:110 10TH ST SW
Mailing Address - Street 2:P O BOX 785
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2924
Mailing Address - Country:US
Mailing Address - Phone:319-352-3120
Mailing Address - Fax:319-352-5720
Practice Address - Street 1:110 10TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2924
Practice Address - Country:US
Practice Address - Phone:319-352-3120
Practice Address - Fax:319-352-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA80183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00667OtherBLUE CROSS/BLUE SHIELD
IA0006676Medicaid
IA0006676Medicaid