Healthcare Provider Details

I. General information

NPI: 1184794174
Provider Name (Legal Business Name): MCLD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WASHINGTON ST
VICTOR IA
52347-7778
US

IV. Provider business mailing address

207 2ND AVE SE STE A
CEDAR RAPIDS IA
52401-1238
US

V. Phone/Fax

Practice location:
  • Phone: 319-647-3322
  • Fax: 319-647-2382
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number701
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER TUETKEN
Title or Position: OWNER
Credential: PHARM D
Phone: 319-465-4906