NPIMap

Organization Active NPI

Nudak Ventures LLC

Doing business as NuCara Pharmacy #4

  • Community/Retail Pharmacy
  • Waterloo, IA
National Provider Identifier
1700987435
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1112 Issued in IA
Legal business name
NUDAK VENTURES LLC
Doing business as
NuCara Pharmacy #4
Practice address
209 E San Marnan Dr Ste 100
Waterloo, IA 50702-5839
Phone
(319) 236-8891
Fax
(319) 236-9665
NPI assigned
Sep 26, 2006
Last updated
Jun 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

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

Authorized official

Name
Lori Ann Willis
Title
Acquisitions Manager
Phone
(515) 280-2927

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 1112 IA Primary

Addresses

Primary practice location

209 E San Marnan Dr Ste 100
Waterloo, IA 50702-5839

Mailing address

PO Box 640
Conrad, IA 50621-0640
Phone (641) 366-3440

Other identifiers 1

IdentifierTypeStateIssuer
1620358OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • NuCara Pharmacy #4 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131111001001 IA Part B Supplier - Mass Immunization (Roster Biller Only) 5395907141 23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conrad, IA; Ackley, IA; Zearing, IA; West Union, IA; Waterloo, IA; Traer, IA; Story City, IA; Pleasant Hill, IA…
O20220419002811 IA Part B Supplier - Independent Clinical Laboratory 5395907141 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Zearing, IA; West Union, IA; Waterloo, IA; Traer, IA; Story City, IA; Pleasant Hill, IA; Ottumwa, IA; Nevada, IA…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1700987435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "CONRAD",
            "state": "IA",
            "postal_code": "506210640",
            "telephone_number": "641-366-3440",
            "fax_number": "641-366-3442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 E SAN MARNAN DR STE 100",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025839",
            "telephone_number": "319-236-8891",
            "fax_number": "319-236-9665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUDAK VENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "LORI ANN",
        "authorized_official_title_or_position": "ACQUISITIONS MANAGER",
        "authorized_official_telephone_number": "515-280-2927"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "1112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1620358",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NuCara Pharmacy #4",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.