Organization
MEDICAP PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MCKONE BURKS RPH (OWNER)
(563) 382-8765
Entity
Organization
Contact information
Practice address
702 MONTGOMERY ST, STE B, DECORAH, IA 52101-2317
(563) 382-8765
(563) 382-1329
Mailing address
702 MONTGOMERY ST, STE B, DECORAH, IA 52101-2317
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
1295
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245110001
—
IA
01
—
1622718
OTHER ID NUMBER
—
Enumeration date
08/23/2006
Last updated
07/19/2007
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