MEDICARE: NUCARA LONG TERM CARE PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	1308	IA

General Provider Information

NPI Number	:	1821285842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUCARA LONG TERM CARE PHARMACY, LLC

Provider Business Mailing Address
First Line	:	2400 4TH ST SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-4664
Country	:	US
Telephone Number	:	641-494-2523
Fax Number	:	641-494-2524

Provider Business Practice Location Address
First Line	:	2400 4TH ST SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-4664
Country	:	US
Telephone Number	:	641-494-2523
Fax Number	:	641-494-2524

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRIAN J. WEGMANN
Credential	:
Telephone Number	:	641-366-3440

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	10/03/2007

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