Provider Demographics
NPI:1437212149
Name:OAKLAND PHARMACY INC
Entity type:Organization
Organization Name:OAKLAND PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-321-7644
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:IA
Mailing Address - Zip Code:51560-0637
Mailing Address - Country:US
Mailing Address - Phone:712-482-3015
Mailing Address - Fax:
Practice Address - Street 1:601 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:IA
Practice Address - Zip Code:51560
Practice Address - Country:US
Practice Address - Phone:712-482-3015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1081174Medicaid
IA159OtherSTATE LICENSE
IA1081174Medicaid
IA1081174Medicaid