Provider Demographics
NPI:1922231364
Name:NUDAK VENTURES, LLC
Entity Type:Organization
Organization Name:NUDAK VENTURES, LLC
Other - Org Name:NUCARA PHARMACY #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-366-3440
Mailing Address - Street 1:209 E SAN MARNAN DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5839
Mailing Address - Country:US
Mailing Address - Phone:319-236-8891
Mailing Address - Fax:319-236-9665
Practice Address - Street 1:209 E SAN MARNAN DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5839
Practice Address - Country:US
Practice Address - Phone:319-236-8891
Practice Address - Fax:319-236-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2023-05-08
Deactivation Date:2022-04-28
Deactivation Code:
Reactivation Date:2023-05-08
Provider Licenses
StateLicense IDTaxonomies
IA8823336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1922231364OtherBCBS