Healthcare Provider Details

I. General information

NPI: 1639212806
Provider Name (Legal Business Name): MERCY FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 N 4TH STREET MERCY MEDICAL CENTER CLINTON
CLINTON IA
52732
US

IV. Provider business mailing address

250 MERCY DRIVE
DUBUQUE IA
52001
US

V. Phone/Fax

Practice location:
  • Phone: 563-244-5555
  • Fax: 563-244-5568
Mailing address:
  • Phone: 563-589-9808
  • Fax: 563-244-5568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number964
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number964
License Number StateIA

VIII. Authorized Official

Name: KAY TAKES
Title or Position: PRESIDENT/CEO
Credential:
Phone: 563-589-8061