Organization
NUDAK VENTURES LLC
Active
Other names
NuCara Pharmacy #16
Organization subpart
No
Provider details
NPI number
Authorized official
LORI ANN WILLIS (ACQUISITIONS MANAGER)
(641) 366-3440
Entity
Organization
Contact information
Practice address
107 W MAIN ST STE A, OTTUMWA, IA 52501-2542
(641) 684-5453
(641) 684-5407
Mailing address
107 W MAIN ST, OTTUMWA, IA 52501-2542
(641) 684-5453
(641) 684-5407
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
809
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0210209
—
IA
01
—
2136154
PK
—
Enumeration date
06/29/2006
Last updated
06/12/2019
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