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BLACKHAWK PHARMACY NPI 1023505542


NPI Information

NPI: 1023505542
Provider Name: BLACKHAWK PHARMACY

Doing Business As: EVANS CROSSING PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 16D2172732

Address:
3506 LAFAYETTE RD
EVANSDALE, IA
ZIP 50707
Phone: (319) 233-3395
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BLACKHAWK PHARMACY is a community/retail pharmacy pharmacy in Evansdale, IA. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. BLACKHAWK PHARMACY NPI is 1023505542. The provider is registered as an organization entity type.
The provider Is Doing Business As Evans Crossing Pharmacy.

The provider's business location address is:

3506 LAFAYETTE RD
EVANSDALE, IA
ZIP 50707-025
Phone: (319) 233-3395
Fax: (319) 233-3099

The provider's authorized official is Robert Greenwood .
The authorized official title is Owner and has the following contact phone number (319) 236-6673.

The CLIA number assigned to this NPI record is 16D2172732 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/19/2018 and was last updated on 5/25/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261Q00000XClinic/CenterNo
2333600000XPharmacyNo
33336C0003XPharmacyCommunity/Retail Pharmacy1644IOWAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12176663OTHERPK
21023505542MEDICAIDIOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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