Provider Demographics
NPI:1619966405
Name:MCLD CORPORATION
Entity Type:Organization
Organization Name:MCLD CORPORATION
Other - Org Name:WEST LIBERTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:TUETKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-465-4906
Mailing Address - Street 1:105 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52776-1401
Mailing Address - Country:US
Mailing Address - Phone:319-627-4317
Mailing Address - Fax:319-627-2037
Practice Address - Street 1:105 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52776-1401
Practice Address - Country:US
Practice Address - Phone:319-465-4906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy