Eby Drug Store (Logan), Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

603 Issued in IA

Legal business name

EBY DRUG STORE (LOGAN), INC

Practice address

103 N 4TH Ave
Logan, IA 51546

Phone

(712) 644-2160

Fax

(712) 644-2103

NPI assigned

Sep 28, 2006

Organization subpart

No

Name

Stephen P. Eby

Title

President

Phone

(712) 644-2848

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

• Stephanie Witt, PHARM. D.

  • Pharmacist
  • Logan, IA
  • NPI 1073908448
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 12, 2011.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305158400000",
    "number": "1821189366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 N 4TH AVE",
            "address_2": "P.O. BOX 187",
            "city": "LOGAN",
            "state": "IA",
            "postal_code": "51546",
            "telephone_number": "712-644-2160",
            "fax_number": "712-644-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N 4TH AVE",
            "city": "LOGAN",
            "state": "IA",
            "postal_code": "51546",
            "telephone_number": "712-644-2160",
            "fax_number": "712-644-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBY DRUG STORE (LOGAN), INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2011-05-12",
        "status": "A",
        "authorized_official_last_name": "EBY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-644-2848"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0079558",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Logan, IA
• Community/Retail Pharmacy in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2011; 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.