Provider Demographics
NPI:1588900047
Name:PM ACQUISITION, LLC
Entity type:Organization
Organization Name:PM ACQUISITION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACQUISITIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-366-3440
Mailing Address - Street 1:PO BOX 3034
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-3034
Mailing Address - Country:US
Mailing Address - Phone:319-337-8649
Mailing Address - Fax:319-337-8659
Practice Address - Street 1:3526 DOLPHIN DR SE
Practice Address - Street 2:SE
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-8202
Practice Address - Country:US
Practice Address - Phone:319-337-8649
Practice Address - Fax:319-337-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
IA14493336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1588900047Medicaid
IA1588900047Medicaid