Provider Demographics
NPI:1720886344
Name:STATE UNIVERSITY OF IOWA
Entity type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIR OF GOV'T REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKELVEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:319-467-8549
Mailing Address - Street 1:411 LAUREL ST STE A302
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3017
Mailing Address - Country:US
Mailing Address - Phone:515-558-6549
Mailing Address - Fax:
Practice Address - Street 1:411 LAUREL ST STE A302
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-558-6549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy