Healthcare Provider Details

I. General information

NPI: 1962573774
Provider Name (Legal Business Name): MERCY FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ASSOCIATES DR
DUBUQUE IA
52002-2201
US

IV. Provider business mailing address

1500 ASSOCIATES DR
DUBUQUE IA
52002-2260
US

V. Phone/Fax

Practice location:
  • Phone: 563-584-4405
  • Fax: 563-584-4404
Mailing address:
  • Phone: 563-584-4405
  • Fax: 563-584-4404

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 Number879
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

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