Provider Demographics
NPI:1669569521
Name:MERCY FAMILY PHARMACY
Entity type:Organization
Organization Name:MERCY FAMILY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-589-8061
Mailing Address - Street 1:535 HILL ST
Mailing Address - Street 2:STE D
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:535 HILL ST
Practice Address - Street 2:STE B
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6678
Practice Address - Country:US
Practice Address - Phone:563-588-4033
Practice Address - Fax:563-588-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA943336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0214890Medicaid
1617072OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA3896690002Medicare NSC
IA0214890Medicaid
1617072OtherOTHER ID NUMBER-COMMERCIAL NUMBER