Provider Demographics
NPI:1194887919
Name:ALLIMONT PHARMACIES INC
Entity type:Organization
Organization Name:ALLIMONT PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-278-4476
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50619-0626
Mailing Address - Country:US
Mailing Address - Phone:319-278-4476
Mailing Address - Fax:319-278-4966
Practice Address - Street 1:111 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IA
Practice Address - Zip Code:50619
Practice Address - Country:US
Practice Address - Phone:319-278-4476
Practice Address - Fax:319-278-4966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIMONT PHARMACIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-15
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0185264Medicaid
0446400003Medicare NSC