Provider Demographics
NPI:1992755615
Name:C R PHARMACY SERVICE INC
Entity type:Organization
Organization Name:C R PHARMACY SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-363-4554
Mailing Address - Street 1:402 10TH ST SE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2459
Mailing Address - Country:US
Mailing Address - Phone:319-298-0953
Mailing Address - Fax:319-298-0954
Practice Address - Street 1:402 10TH ST SE
Practice Address - Street 2:SUITE 600
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2459
Practice Address - Country:US
Practice Address - Phone:319-298-0953
Practice Address - Fax:319-298-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5641332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159772Medicaid
IA0146630007Medicare NSC