Organization
MCLD CORPORATION
Active
Other names
WYOMING DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER TUETKEN PHARM D (PHARMACIST)
(319) 221-1050
Entity
Organization
Contact information
Practice address
156 W MAIN ST, WYOMING, IA 52362-7748
(563) 488-3322
(563) 488-3383
Mailing address
209 2ND ST SE, CEDAR RAPIDS, IA 52401-1405
(319) 221-1050
(319) 221-1033
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
390
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0424960
—
IA
01
—
2026823
PK
—
Enumeration date
10/17/2005
Last updated
08/05/2014
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