Healthcare Provider Details

I. General information

NPI: 1922034131
Provider Name (Legal Business Name): MERCY FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LANGWORTHY ST
DUBUQUE IA
52001-7313
US

IV. Provider business mailing address

1000 LANGWORTHY ST
DUBUQUE IA
52001-7313
US

V. Phone/Fax

Practice location:
  • Phone: 563-584-3405
  • Fax:
Mailing address:
  • Phone: 563-584-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number481
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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