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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