Provider Demographics
NPI:1952490500
Name:MONTROSS PHARMACY INC
Entity Type:Organization
Organization Name:MONTROSS PHARMACY INC
Other - Org Name:MONTROSS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-462-2282
Mailing Address - Street 1:118-120 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-1594
Mailing Address - Country:US
Mailing Address - Phone:515-462-2282
Mailing Address - Fax:515-465-2296
Practice Address - Street 1:118-120 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-1594
Practice Address - Country:US
Practice Address - Phone:515-462-2282
Practice Address - Fax:515-465-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA2633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2026306OtherPK
IA0031955Medicaid
1604657OtherNCPDP PROVIDER IDENTIFICATION NUMBER