Provider Demographics
NPI:1588894281
Name:MEDONE PHARMACY SERVICES
Entity type:Organization
Organization Name:MEDONE PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIBELHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:563-588-8700
Mailing Address - Street 1:1580 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001
Mailing Address - Country:US
Mailing Address - Phone:877-896-0919
Mailing Address - Fax:563-588-0173
Practice Address - Street 1:1580 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001
Practice Address - Country:US
Practice Address - Phone:877-896-0919
Practice Address - Fax:563-588-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13603336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy