# MCLD CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PHILCARE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588867998
- **Authorized official:** CHRIS TUETKEN (OWNER PRESIDENT)
- **Authorized official phone:** (319) 465-4906

## Contact information

- **Practice address:** 207 2ND AVE SE STE B, CEDAR RAPIDS, IA 52401-1238
- **Practice address phone:** (319) 221-1050
- **Practice address fax:** (319) 221-1052
- **Mailing address:** 207 2ND AVE SE, SUITE B, CEDAR RAPIDS, IA 52401-1238
- **Mailing address phone:** (319) 221-1050
- **Mailing address fax:** (319) 221-1052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 1316 | IA | Yes |

## Other

- **Enumeration date:** 06/06/2007
- **Last updated:** 04/30/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1588867998 | — | IA |
| 01 | — | 1623075 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |