Provider Demographics
NPI:1164516027
Name:NUDAK VENTURES, LLC
Entity Type:Organization
Organization Name:NUDAK VENTURES, LLC
Other - Org Name:NUCARA PHARMACY #44
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACQUISITIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-366-3440
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:IA
Mailing Address - Zip Code:50621-0640
Mailing Address - Country:US
Mailing Address - Phone:641-366-3440
Mailing Address - Fax:641-366-3442
Practice Address - Street 1:621 G AVE
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-1549
Practice Address - Country:US
Practice Address - Phone:319-824-5446
Practice Address - Fax:319-824-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA834183500000X
332B00000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0133140Medicaid
IA0133140Medicaid