NPIMap

Organization Active NPI

Kallenbach Drug Inc

  • Long Term Care Pharmacy
  • Manchester, IA
National Provider Identifier
1609149749
Registry record updated May 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
188 Issued in IA
Legal business name
KALLENBACH DRUG INC
Practice address
111 S Franklin St
Manchester, IA 52057
Phone
(563) 927-4755
Fax
(563) 927-4110
NPI assigned
Feb 21, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jonathan Kallenbach, PHARM D
Title
Owner- Pharmacist in Charge
Phone
(563) 927-4463

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 188 IA Primary

Addresses

Primary practice location

111 S Franklin St
Manchester, IA 52057

Mailing address

PO Box 99
Manchester, IA 52057-0099
Phone (563) 927-4755

Other identifiers 1

IdentifierTypeStateIssuer
1624205OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Widner Drug Store Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kallenbach Drug Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526428800000",
    "number": "1609149749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "520570099",
            "telephone_number": "563-927-4755",
            "fax_number": "563-927-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S FRANKLIN ST",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "52057",
            "telephone_number": "563-927-4755",
            "fax_number": "563-927-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALLENBACH DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-21",
        "last_updated": "2018-05-16",
        "status": "A",
        "authorized_official_last_name": "KALLENBACH",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER- PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "563-927-4463",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IA",
            "license": "188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1624205",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Widner Drug Store",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Widner Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manchester, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.