Provider Demographics
NPI:1306304027
Name:STATE UNIVERSITY OF IOWA
Entity type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR DIR OF GOVT REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKELVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-467-8549
Mailing Address - Street 1:1360 N DODGE ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-6104
Mailing Address - Country:US
Mailing Address - Phone:319-678-8222
Mailing Address - Fax:319-467-6048
Practice Address - Street 1:1360 N DODGE ST STE 1100
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-6104
Practice Address - Country:US
Practice Address - Phone:319-678-8222
Practice Address - Fax:319-467-6048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE UNIVERSITY OF IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-12
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy