Organization
LINCOLN HIGHWAY PHARMACY, INC.
Active
Organization
LINCOLN HIGHWAY PHARMACY, INC.
Active
Other names
Clinic Pharmacy of Carroll
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD FLESHNER (OWNER)
(712) 792-5393
Entity
Organization
Contact information
Practice address
405 S CLARK ST STE 102, CARROLL, IA 51401-3065
(712) 792-5393
(712) 792-2403
Mailing address
859 E US HIGHWAY 30, C/O LINCOLN HIGHWAY PHARMACY, CARROLL, IA 51401-2617
(712) 792-2402
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1384
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1624003
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/03/2011
Last updated
02/03/2011
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