1659616225 NPI number — SWEET SPRINGS PHARMACY INC

Table of content: (NPI 1659616225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659616225 NPI number — SWEET SPRINGS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWEET SPRINGS PHARMACY INC
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:
6
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:
1659616225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64601-0737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-707-0906
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 N MISSOURI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARCELINE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-376-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
660-247-1580

Provider Taxonomy Codes

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

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

  • Identifier: 5576550001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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