Organization
ST ANTHONY WALL LAKE PHARMACY
Active
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
Update your record
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