Organization
BLACKHAWK PHARMACY
Active
Other names
Evans Crossing Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WESLEY CHARLES PILKINGTON PHARMD (OFFICER)
(319) 233-3395
Entity
Organization
Contact information
Practice address
3506 LAFAYETTE RD, EVANSDALE, IA 50707-1025
(319) 233-3395
(319) 233-3099
Mailing address
3506 LAFAYETTE RD, EVANSDALE, IA 50707-1025
(319) 233-3395
(319) 233-3099
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1644
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023505542
—
IA
01
—
2176663
PK
—
Enumeration date
04/19/2018
Last updated
05/09/2024
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