Organization
CORYDON PHARMACY INC
Active
Other names
NESSEN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK NESSEN (PRESIDENT AND OWNER)
(641) 872-2512
Entity
Organization
Contact information
Practice address
104 S FRANKLIN ST, CORYDON, IA 50060-1518
(641) 872-2512
(641) 872-1078
Mailing address
PO BOX 385, CORYDON, IA 50060-0385
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
595
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085902
—
IA
01
—
1605469
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
602208407
—
MO
Enumeration date
08/23/2005
Last updated
02/16/2010
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