Organization
STL HEALTH RESOURCES CO.
Active
Parent organization
STL HEALTH RESOURCES CO.
Other names
Custom Care Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
STL HEALTH RESOURCES CO.
Authorized official
MRS. JESSICA K HAVEL PHARMD (PROGRAM MANAGER - RETAIL PHARMACY)
(319) 369-7403
Entity
Organization
Contact information
Practice address
855 A AVE NE STE 110, CEDAR RAPIDS, IA 52402-5060
(319) 369-7403
Mailing address
855 A AVE NE STE 110, CEDAR RAPIDS, IA 52402-5060
(319) 369-7403
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1321
IA
3336C0003X
Community/Retail Pharmacy
Primary
1321
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0432090010
MEDICARE DME SUPPLIER
IA
05
—
1427268655
—
IA
01
—
1623051
NCPDP
IA
01
—
I20972
MEDICARE PTAN
IA
Enumeration date
05/23/2007
Last updated
11/03/2008
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