Provider Demographics
NPI:1821285842
Name:NUCARA LONG TERM CARE PHARMACY, LLC
Entity Type:Organization
Organization Name:NUCARA LONG TERM CARE PHARMACY, LLC
Other - Org Name:NUCARA PHARMACY # 18
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-366-3440
Mailing Address - Street 1:2400 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4664
Mailing Address - Country:US
Mailing Address - Phone:641-494-2523
Mailing Address - Fax:641-494-2524
Practice Address - Street 1:2400 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4664
Practice Address - Country:US
Practice Address - Phone:641-494-2523
Practice Address - Fax:641-494-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy