Organization
MCLD CORPORATION
Active
Organization
MCLD CORPORATION
Active
Other names
VILLAGE PHARMACY VICTOR
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER TUETKEN PHARM D (OWNER)
(319) 465-4906
Entity
Organization
Contact information
Practice address
205 WASHINGTON ST, VICTOR, IA 52347-7778
(319) 647-3322
(319) 647-2382
Mailing address
207 2ND AVE SE, STE A, CEDAR RAPIDS, IA 52401-1238
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
701
IA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0421313
—
IA
01
—
1604289
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/08/2006
Last updated
04/08/2010
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