Provider Demographics
NPI:1124512223
Name:PRESCRIPTION SHOPPE TELEPHARMACY, LLC
Entity type:Organization
Organization Name:PRESCRIPTION SHOPPE TELEPHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGHTINGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-780-9548
Mailing Address - Street 1:1020 12TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-1919
Mailing Address - Country:US
Mailing Address - Phone:563-581-2508
Mailing Address - Fax:
Practice Address - Street 1:139 N LAWLER ST
Practice Address - Street 2:
Practice Address - City:POSTVILLE
Practice Address - State:IA
Practice Address - Zip Code:52162-7799
Practice Address - Country:US
Practice Address - Phone:563-863-3666
Practice Address - Fax:563-863-3667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESCRIPTION SHOPPE TELEPHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-21
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy