Provider Demographics
NPI:1679552004
Name:CENTRAL CITY FAMILY PHARMACY, INC.
Entity type:Organization
Organization Name:CENTRAL CITY FAMILY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDERSCHEID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:319-438-1988
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52214-0368
Mailing Address - Country:US
Mailing Address - Phone:319-438-1988
Mailing Address - Fax:319-438-1094
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:IA
Practice Address - Zip Code:52214-9454
Practice Address - Country:US
Practice Address - Phone:319-438-1988
Practice Address - Fax:319-438-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
IA7973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0061689Medicaid
1616258OtherOTHER ID NUMBER
IA0061689Medicaid