Organization
CARROLL APOTHECARY, INC
Active
Other names
Home Care Medical Equipment
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA IRLBECK (MANAGER)
(712) 792-4591
Entity
Organization
Contact information
Practice address
425 HIGHWAY 30 WEST, SUITE 140, CARROLL, IA 51401-0157
(712) 792-4591
(712) 792-0894
Mailing address
PO BOX 157, CARROLL, IA 51401-0157
(712) 792-4591
(712) 792-0894
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
IA
3336H0001X
Home Infusion Therapy Pharmacy
357
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0089276
—
IA
01
—
0187963
MEDICAID WAIVER PROVIDER
IA
01
—
09897
WELLMARK BC/BS
IA
Enumeration date
08/24/2005
Last updated
06/19/2012
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