Organization
ST ANTHONY WALL LAKE PHARMACY
Active
Other names
ST ANTHONY WALL LAKE PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY FLESHNER (PHARMACIST IN CHARGE)
(712) 664-2801
Entity
Organization
Contact information
Practice address
311 W 1ST ST, WALL LAKE, IA 51466-7014
(712) 664-2801
(712) 664-2820
Mailing address
311 W 1ST ST, WALL LAKE, IA 51466-7014
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
966
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0104836
—
IA
01
—
1617488
OTHER ID NUMBER
—
Enumeration date
11/16/2006
Last updated
07/31/2007
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