Organization
COVENANT MEDICAL CENTER INC
Active
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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