Provider Demographics
NPI:1972643914
Name:CONSULTANT PHARMACISTS INC
Entity type:Organization
Organization Name:CONSULTANT PHARMACISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:712-374-2513
Mailing Address - Street 1:714 ILLINOIS STREET
Mailing Address - Street 2:PO BOX 360
Mailing Address - City:SIDNEY
Mailing Address - State:IA
Mailing Address - Zip Code:51652
Mailing Address - Country:US
Mailing Address - Phone:712-374-2513
Mailing Address - Fax:712-374-3171
Practice Address - Street 1:714 ILLINOIS STREET
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:IA
Practice Address - Zip Code:51652
Practice Address - Country:US
Practice Address - Phone:712-374-2513
Practice Address - Fax:712-374-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IA5073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0073288Medicaid
0423380001Medicare NSC