Provider Demographics
NPI:1386535771
Name:STATE UNIVERSITY OF IOWA
Entity type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF GOVERNMENT REIMB
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 1:2901 86TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4330
Mailing Address - Country:US
Mailing Address - Phone:555-102-0721
Mailing Address - Fax:515-666-4500
Practice Address - Street 1:2901 86TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4330
Practice Address - Country:US
Practice Address - Phone:555-102-0721
Practice Address - Fax:515-666-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy