Organization
EVANSDALE PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RIC E. FOREMAN R.PH. (PRESIDENT)
(319) 233-3395
Entity
Organization
Contact information
Practice address
3506 LAFAYETTE RD, EVANSDALE, IA 50707-1025
(319) 233-3395
Mailing address
3506 LAFAYETTE RD, EVANSDALE, IA 50707-1025
(319) 233-3395
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
513
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076547
—
IA
Enumeration date
02/21/2007
Last updated
08/22/2020
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