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Organization
DES MOINES CENTRAL CORRECTIONAL PHARMACY
Active
Organization
DES MOINES CENTRAL CORRECTIONAL PHARMACY
Active
Other names
Des Moines Central Correctional Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY LEE (PHARMACY SUPERVISOR)
(515) 725-5065
Entity
Organization
Contact information
Practice address
250 ELM AVE SW, MITCHELLVILLE, IA 50169-9610
(515) 725-5065
(515) 725-5070
Mailing address
250 ELM AVE SW, MITCHELLVILLE, IA 50169-9610
(515) 725-5065
(515) 725-5070
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
1456
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176604
PK
—
Enumeration date
03/30/2018
Last updated
03/30/2018
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