Organization
KIMWOOD, INC.
Active
Other names
Medicap Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS A. JORGENSEN R. PH. (V.P./MANAGER)
(712) 563-2655
Entity
Organization
Contact information
Practice address
316 BROADWAY ST, AUDUBON, IA 50025-1104
(712) 563-2655
(712) 563-2656
Mailing address
316 BROADWAY ST, AUDUBON, IA 50025-1104
(712) 563-2655
(712) 563-2656
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
813
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0254383
—
IA
01
—
1614329
NCPDP #
IA
Enumeration date
05/12/2006
Last updated
03/07/2023
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