Organization
SERGEANT BLUFF PHARMACY INC
Active
Other names
SERGEANT BLUFF PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY A JACKSON (OWNER)
(712) 943-1494
Entity
Organization
Contact information
Practice address
105 GAUL DR STE A, SERGEANT BLUFF, IA 51054-8963
(712) 943-1494
(712) 943-1496
Mailing address
105 GAUL DR STE A, SERGEANT BLUFF, IA 51054-8963
(712) 943-1494
(712) 943-1496
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1304
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0736173
—
IA
05
—
10025475600
—
NE
01
—
2030418
PK
—
Enumeration date
11/08/2006
Last updated
01/28/2021
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