Provider Demographics
NPI:1932257599
Name:BOVY RX
Entity type:Organization
Organization Name:BOVY RX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOVY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:319-788-7445
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-0330
Mailing Address - Country:US
Mailing Address - Phone:319-346-1970
Mailing Address - Fax:319-346-1585
Practice Address - Street 1:226 3RD STREET
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:IA
Practice Address - Zip Code:50665-0330
Practice Address - Country:US
Practice Address - Phone:319-346-1970
Practice Address - Fax:319-346-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336M0002X, 333600000X, 3336L0003X
IAIA8713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1109016OtherSTATE CONTROLLED SUBSTANCE LICENSE
1608162OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA5575OtherSTATE PHARMACY LICENSE
1608162OtherOTHER ID NUMBER
IA0125997Medicaid