Organization
JEFF LONGSTAFF CORPORATION
Active
Other names
Medicap Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX PETTIT PHARMD (PHARMACIST IN CHARGE)
(641) 782-6558
Entity
Organization
Contact information
Practice address
405 S SUMNER AVE, CRESTON, IA 50801-3330
(641) 782-6558
(641) 782-7346
Mailing address
405 S SUMNER AVE, CRESTON, IA 50801-3330
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
850
IA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0201715
—
IA
01
—
1613478
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/03/2006
Last updated
10/15/2024
About Stedi
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