Organization
ALLEN MEMORIAL HOSPITAL
Active
Other names
UNITED MED PARK CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA GANSEN R PH (PHARMACY COORDINATOR PIC)
(319) 833-5725
Entity
Organization
Contact information
Practice address
1731 W RIDGEWAY AVE, WATERLOO, IA 50701-4595
(319) 833-5725
(319) 833-5729
Mailing address
1731 W RIDGEWAY AVE, WATERLOO, IA 50701-4595
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1028
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0175554
—
IA
01
—
1619115
OTHER ID NUMBER
—
Enumeration date
07/11/2005
Last updated
09/13/2007
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