Provider Demographics
NPI:1295801959
Name:BEANO RX PC
Entity type:Organization
Organization Name:BEANO RX PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC TREAS
Authorized Official - Prefix:
Authorized Official - First Name:TORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:319-653-4646
Mailing Address - Street 1:222 S IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 S IOWA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1736
Practice Address - Country:US
Practice Address - Phone:319-653-4646
Practice Address - Fax:319-653-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
IA435333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1602982OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA0128843Medicaid
IA0128843Medicaid