Organization
COVENANT MEDICAL CENTER INC
Active
Other names
MercyOne LaPorte City Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY HUBER (CONTROLLER)
(319) 272-7607
Entity
Organization
Contact information
Practice address
601 HIGHWAY 218 N, LA PORTE CITY, IA 50651-1012
(319) 342-3620
(319) 342-3617
Mailing address
2710 SAINT FRANCIS DR, SUITE 101, WATERLOO, IA 50702-5619
(319) 272-5277
(319) 272-0188
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
827
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193482
—
IA
01
—
2130099
PK
—
Enumeration date
06/09/2006
Last updated
10/10/2024
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