Provider Demographics
NPI:1932619475
Name:PELLA REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:PELLA REGIONAL HEALTH CENTER
Other - Org Name:PELLA REGIONAL HEALTH CENTER CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RETAIL PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:BREEMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:641-628-1612
Mailing Address - Street 1:405 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219
Mailing Address - Country:US
Mailing Address - Phone:641-621-2444
Mailing Address - Fax:641-628-2164
Practice Address - Street 1:405 MONROE ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219
Practice Address - Country:US
Practice Address - Phone:641-628-6616
Practice Address - Fax:641-621-2357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PELLA REGIONAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-11
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336S0011X
IA333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy