Pharma340 LLC
Organization Active NPI Community/Retail Pharmacy · Gowrie, IA
NPI 1780143016 · NPPES record last updated Dec 17, 2024
Key facts
- NPI
- 1780143016
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- PHARMA340 LLC
- Practice address
- 1800 Main St
Gowrie, IA 50543-7438 - Phone
- (515) 352-3876
- NPI assigned
- Mar 16, 2019
- Organization subpart
- No
Authorized official
- Name
- Steven Donnelly
- Title
- Vice President
- Phone
- (210) 441-2036
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190829002201 | IA | Part B Supplier - Mass Immunization (Roster Biller Only) | 2567799505 |
5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rockwell City, IA; Sac City, IA; Lake View, IA; Lake City, IA; Dunlap, IA; Gowrie, IA |
National Provider Directory
- Tax ID family
- Pharma340 LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes | ||
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
1800 Main St
Gowrie, IA 50543-7438
Mailing address
1321 W Main St
Lake City, IA 51449-1585
Phone (712) 830-5443
Other names
- Community Pharmacy of Gowrie
Other providers in Gowrie, IA
- Judisch Vision PC
- Jennifer Knapp
- David Martin Palmer
- Pearl Valley Rehabilitation and Nursing at Gowrie, LLC
- Elizabeth Jean Peterson
- Prairie Valley CSD
- Bruce Pudenz
- Signature Properties of Gowrie, LLC
- Southeast Valley Community School District
- Southwest Webster Ambulance Service
All providers in Gowrie, IA · Community/Retail Pharmacy in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.