| Blackhawk Pharmacy | |
|
3506 Lafayette Rd Evansdale IA 50707-1025 | |
| (319) 233-3395 | |
| (319) 233-3099 |
| Full Name | Blackhawk Pharmacy |
|---|---|
| Speciality | Pharmacy |
| Location | 3506 Lafayette Rd, Evansdale, Iowa |
| Authorized Official Name and Position | Wesley Charles Pilkington (OFFICER) |
| Authorized Official Contact | 3192333395 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackhawk Pharmacy 3506 Lafayette Rd Evansdale IA 50707-1025 Ph: (319) 233-3395 | Blackhawk Pharmacy 3506 Lafayette Rd Evansdale IA 50707-1025 Ph: (319) 233-3395 |
| NPI Number | 1023505542 |
|---|---|
| Provider Enumeration Date | 04/19/2018 |
| Last Update Date | 05/09/2024 |
| Medicare PECOS PAC ID | 2860803939 |
|---|---|
| Medicare Enrollment ID | O20201120000652 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023505542 | NPI | - | NPPES |
| 2176663 | Other | PK | |
| 1023505542 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 333600000X | Pharmacy | (* (Not Available)) | Secondary |
| 3336C0003X | Pharmacy - Community/retail Pharmacy | 1644 (Iowa) | Primary |