Organization
EBY DRUG STORE (LOGAN), INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN P. EBY (PRESIDENT)
(712) 644-2848
Entity
Organization
Contact information
Practice address
103 N 4TH AVE, LOGAN, IA 51546
(712) 644-2160
(712) 644-2103
Mailing address
103 N 4TH AVE, P.O. BOX 187, LOGAN, IA 51546
(712) 644-2160
(712) 644-2103
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
603
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0079558
—
IA
Enumeration date
09/28/2006
Last updated
05/12/2011
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