Provider Demographics
NPI:1942298807
Name:MCLD CORPORATION
Entity Type:Organization
Organization Name:MCLD CORPORATION
Other - Org Name:STAR DRUG
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 1:517 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52361
Mailing Address - Country:US
Mailing Address - Phone:319-668-1520
Mailing Address - Fax:319-668-8178
Practice Address - Street 1:517 COURT STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361
Practice Address - Country:US
Practice Address - Phone:319-668-1520
Practice Address - Fax:319-668-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty