Provider Demographics
NPI:1669554457
Name:DONLON DRUG INC
Entity type:Organization
Organization Name:DONLON DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FRERICHS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:319-352-3120
Mailing Address - Street 1:110 10TH ST SW
Mailing Address - Street 2:C/O MEYER PHARMACY
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2924
Mailing Address - Country:US
Mailing Address - Phone:319-352-3120
Mailing Address - Fax:319-352-5720
Practice Address - Street 1:1817 STATE HIGHWAY 9 STE 3
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7505
Practice Address - Country:US
Practice Address - Phone:563-259-7894
Practice Address - Fax:563-275-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IA14953336C0003X
IA4003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0111944Medicaid
IA0111944Medicaid
IA0111944Medicaid
2144260OtherPK