Provider Demographics
NPI:1104318989
Name:TOWNCREST PHARMACY CORP.
Entity type:Organization
Organization Name:TOWNCREST PHARMACY CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DENINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-3526
Mailing Address - Street 1:2306 MUSCATINE AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6637
Mailing Address - Country:US
Mailing Address - Phone:319-337-3526
Mailing Address - Fax:319-337-5271
Practice Address - Street 1:2223 F ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6637
Practice Address - Country:US
Practice Address - Phone:319-688-4398
Practice Address - Fax:319-337-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
IA8383336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177968OtherPK