Organization
RURAL RX LLC
Active
Other names
Coon Rapids Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA YOUNGBLOOD PHARM. D. (OWNER/PIC)
(515) 386-2164
Entity
Organization
Contact information
Practice address
515 MAIN STREET, COON RAPIDS, IA 50058
(712) 999-6337
(712) 999-7979
Mailing address
400 N ELM ST, JEFFERSON, IA 50129-1420
(575) 386-2164
(515) 386-8521
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0190280
—
IA
01
—
1613048
NCPDP
IA
Enumeration date
04/25/2006
Last updated
12/21/2023
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