Healthcare Provider Details

I. General information

NPI: 1114963576
Provider Name (Legal Business Name): MCLD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 2ND ST SE
CEDAR RAPIDS IA
52401-1405
US

IV. Provider business mailing address

209 2ND ST SE
CEDAR RAPIDS IA
52401-1405
US

V. Phone/Fax

Practice location:
  • Phone: 319-221-1050
  • Fax: 319-221-1033
Mailing address:
  • Phone: 319-221-1050
  • Fax: 319-221-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1281
License Number StateIA

VIII. Authorized Official

Name: CHRISTOPHER TUETKEN
Title or Position: OWNER
Credential:
Phone: 319-221-1050