Provider Demographics
NPI:1699867994
Name:OSTERHAUS PHARMACY, INC.
Entity type:Organization
Organization Name:OSTERHAUS PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:OSTERHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-652-5611
Mailing Address - Street 1:918 W PLATT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2038
Mailing Address - Country:US
Mailing Address - Phone:563-652-5611
Mailing Address - Fax:563-652-6242
Practice Address - Street 1:918 W PLATT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2038
Practice Address - Country:US
Practice Address - Phone:563-652-5611
Practice Address - Fax:563-652-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0022087Medicaid
IA0226000001Medicare ID - Type UnspecifiedPROVIDER NUMBER