Organization
MCLD CORPORATION
Active
Other names
PHILCARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS TUETKEN (OWNER PRESIDENT)
(319) 465-4906
Entity
Organization
Contact information
Practice address
207 2ND AVE SE STE B, CEDAR RAPIDS, IA 52401-1238
(319) 221-1050
(319) 221-1052
Mailing address
207 2ND AVE SE, SUITE B, CEDAR RAPIDS, IA 52401-1238
(319) 221-1050
(319) 221-1052
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
1316
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588867998
—
IA
01
—
1623075
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/06/2007
Last updated
04/30/2010
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