Provider Demographics
NPI:1811475064
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 1:876 TANGLEFOOT LN
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1605
Mailing Address - Country:US
Mailing Address - Phone:563-345-6546
Mailing Address - Fax:563-345-6549
Practice Address - Street 1:876 TANGLEFOOT LN
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1605
Practice Address - Country:US
Practice Address - Phone:563-345-6546
Practice Address - Fax:563-345-6549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GBANK HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-31
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16533336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1811475064Medicaid