Organization
CEDAR RAPIDS MED ED FOUND PHCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY C HERBERT PHARMD (PHCY DIR)
(319) 398-6730
Entity
Organization
Contact information
Practice address
610 8TH ST SE, CEDAR RAPIDS, IA 52401-2143
(319) 398-6730
(319) 398-6466
Mailing address
610 8TH ST SE, CEDAR RAPIDS, IA 52401-2143
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
1285
IA
3336C0002X
Clinic Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622491
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/02/2006
Last updated
07/03/2008
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