Provider Demographics
NPI:1427143858
Name:CLINGMAN PHARMACY, INC.
Entity type:Organization
Organization Name:CLINGMAN PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:CLINGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:319-472-4731
Mailing Address - Street 1:200 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-1122
Mailing Address - Country:US
Mailing Address - Phone:319-472-4731
Mailing Address - Fax:319-472-2757
Practice Address - Street 1:200 W 4TH ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-1122
Practice Address - Country:US
Practice Address - Phone:319-472-4731
Practice Address - Fax:319-472-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35OtherSTATE LICENSE NUMBER
IA1601586OtherNCPDP
IA0003640Medicaid
IABC1828889OtherDEA NUMBER
IA0308680001Medicare NSC