Organization
MERCY HEALTH SERVICES-IOWA CORP
Active
Other names
MercyOne Clear Lake Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARK TRAMMEL (ASSISTANT TREASURER)
(641) 428-7984
Entity
Organization
Contact information
Practice address
1410 6TH AVE S STE 200, CLEAR LAKE, IA 50428-2606
(641) 231-8900
(641) 231-8910
Mailing address
PO BOX 1159, MASON CITY, IA 50402-1159
(641) 428-7917
(641) 428-8635
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
1579
IA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0409056
—
IA
01
—
2163823
PK
—
Enumeration date
08/26/2016
Last updated
10/10/2024
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