NPIMap

Organization Active NPI

Kallenbach Drug Inc

Doing business as Widner Drug

  • Community/Retail Pharmacy
  • Manchester, IA
National Provider Identifier
1841212966
Registry record updated May 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
188 Issued in IA
Legal business name
KALLENBACH DRUG INC
Doing business as
Widner Drug
Practice address
111 S Franklin St
Manchester, IA 52057
Phone
(563) 927-4463
Fax
(563) 927-4110
NPI assigned
Jul 25, 2006
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 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) 927-4463

Other identifiers 3

IdentifierTypeStateIssuer
0093351MedicaidIA
1841212966MedicaidIA
2025946OtherPK

Other names 1

  • WIDNER DRUG Doing business as

National Provider Directory

National Provider Directory

Locations

111 S Franklin St
Manchester, IA 52057
Phone (563) 927-4463

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": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526428800000",
    "number": "1841212966",
    "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": "563-927-4463",
            "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": "563-927-4463",
            "fax_number": "563-927-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALLENBACH DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0093351",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841212966",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2025946",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WIDNER DRUG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WIDNER DRUG",
            "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.