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Organization
KALLENBACH DRUG INC
Active
Organization
KALLENBACH DRUG INC
Active
Other names
Widner Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN KALLENBACH PHARM D (OWNER- PHARMACIST IN CHARGE)
(563) 927-4463
Entity
Organization
Contact information
Practice address
111 S FRANKLIN ST, MANCHESTER, IA 52057
(563) 927-4755
(563) 927-4110
Mailing address
PO BOX 99, MANCHESTER, IA 52057-0099
(563) 927-4755
(563) 927-4110
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
188
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1624205
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/21/2012
Last updated
05/16/2018
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