Organization
MCLD CORPORATION
Active
Other names
SUMNER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER TUETKEN PHARM D (PRES)
(319) 221-1050
Entity
Organization
Contact information
Practice address
100 E 1ST ST, SUMNER, IA 50674-1430
(563) 578-5068
(563) 578-5190
Mailing address
207 2ND AVE SE, STE A, CEDAR RAPIDS, IA 52401-1238
(319) 221-1033
(319) 221-1050
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
43
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063687580
—
IA
01
—
1623467
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/25/2008
Last updated
12/28/2009
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