Organization
NUDAK VENTURES LLC
Active
Other names
NuCara Pharmacy #4
Organization subpart
No
Provider details
NPI number
Authorized official
LORI ANN WILLIS (ACQUISITIONS MANAGER)
(641) 366-3440
Entity
Organization
Contact information
Practice address
209 E SAN MARNAN DR STE 100, WATERLOO, IA 50702-5839
(319) 236-8891
(319) 236-9665
Mailing address
PO BOX 640, CONRAD, IA 50621-0640
(641) 366-3440
(641) 366-3442
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1112
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1620358
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/26/2006
Last updated
02/07/2013
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