NPIMap

Organization Active NPI

St Anthony Wall Lake Pharmacy

Doing business as St Anthony Wall Lake Phcy

  • Community/Retail Pharmacy
  • Wall Lake, IA
National Provider Identifier
1821161936
Registry record updated Jul 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
966 Issued in IA
Legal business name
ST ANTHONY WALL LAKE PHARMACY
Doing business as
St Anthony Wall Lake Phcy
Practice address
311 W 1St St
Wall Lake, IA 51466-7014
Phone
(712) 664-2801
Fax
(712) 664-2820
NPI assigned
Nov 16, 2006
Last updated
Jul 31, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2007

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

Authorized official

Name
Jerry Fleshner
Title
Pharmacist in Charge
Phone
(712) 664-2801

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 966 IA Primary

Addresses

Primary practice location

311 W 1St St
Wall Lake, IA 51466-7014

Mailing address

311 W 1St St
Wall Lake, IA 51466-7014

Other identifiers 2

IdentifierTypeStateIssuer
1617488OtherOTHER ID NUMBER
0104836MedicaidIA

Other names 1

  • ST ANTHONY WALL LAKE PHCY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Anthony Regional Hospital11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185840000000",
    "number": "1821161936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 W 1ST ST",
            "city": "WALL LAKE",
            "state": "IA",
            "postal_code": "514667014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W 1ST ST",
            "city": "WALL LAKE",
            "state": "IA",
            "postal_code": "514667014",
            "telephone_number": "712-664-2801",
            "fax_number": "712-664-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST ANTHONY WALL LAKE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-31",
        "status": "A",
        "authorized_official_last_name": "FLESHNER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "712-664-2801"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "1617488",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0104836",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST ANTHONY WALL LAKE PHCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wall Lake, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; 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.