Provider Demographics
NPI:1699476572
Name:PRESCRIPTION SHOPPE, INC.
Entity type:Organization
Organization Name:PRESCRIPTION SHOPPE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGHTINGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-780-9548
Mailing Address - Street 1:1020 12TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-1964
Mailing Address - Country:US
Mailing Address - Phone:563-875-7455
Mailing Address - Fax:
Practice Address - Street 1:304 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1503
Practice Address - Country:US
Practice Address - Phone:319-465-4404
Practice Address - Fax:319-465-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0438812Medicaid