1700906591 NPI number — SINKS PHARMACY SOUTH

Table of content: (NPI 1700906591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700906591 NPI number — SINKS PHARMACY SOUTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SINKS PHARMACY SOUTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700906591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 528
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUBA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65453-0528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-308-4899
Provider Business Mailing Address Fax Number:
573-308-4893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100B S BISHOP AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROLLA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65401-4418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-308-4899
Provider Business Practice Location Address Fax Number:
573-308-4893
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MISSOURI
Authorized Official First Name:
LOCAL HEALTH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-885-0885

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2005000322 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6004007401 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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