NPIMap

Organization Active NPI

MCLD Corporation

Doing business as Village Pharmacy Victor

  • Community/Retail Pharmacy
  • Victor, IA
National Provider Identifier
1184794174
Registry record updated Apr 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
701 Issued in IA
Legal business name
MCLD CORPORATION
Doing business as
Village Pharmacy Victor
Practice address
205 Washington St
Victor, IA 52347-7778
Phone
(319) 647-3322
Fax
(319) 647-2382
NPI assigned
Nov 8, 2006
Last updated
Apr 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Tuetken, PHARM D
Title
Owner
Phone
(319) 465-4906

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 701 IA Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

205 Washington St
Victor, IA 52347-7778

Mailing address

207 2ND Ave SE
Ste a
Cedar Rapids, IA 52401-1238

Other identifiers 2

IdentifierTypeStateIssuer
1604289OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0421313MedicaidIA

Other names 1

  • VILLAGE PHARMACY VICTOR Doing business as

National Provider Directory

National Provider Directory
Tax ID family
MCLD Corporation5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270684800000",
    "number": "1184794174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 2ND AVE SE",
            "address_2": "STE A",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524011238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 WASHINGTON ST",
            "city": "VICTOR",
            "state": "IA",
            "postal_code": "523477778",
            "telephone_number": "319-647-3322",
            "fax_number": "319-647-2382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLD CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2010-04-08",
        "status": "A",
        "authorized_official_last_name": "TUETKEN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-465-4906",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "701",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1604289",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0421313",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VILLAGE PHARMACY VICTOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victor, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.