MEDICARE: SEMO DRUG OF KENNETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053514356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEMO DRUG OF KENNETT

Provider Business Mailing Address
First Line	:	1312 1ST ST
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-2526
Country	:	US
Telephone Number	:	573-888-8880
Fax Number	:	573-888-3889

Provider Business Practice Location Address
First Line	:	1312 1ST ST
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-2526
Country	:	US
Telephone Number	:	573-888-8880
Fax Number	:	573-888-3889

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	DR. TYSON WALLACE
Credential	:	PHARM.D.
Telephone Number	:	573-888-8880

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1235132648 — TERESITA I MANUBAY MD
Practice Location Address:

1312 1ST ST
KENNETT, MO
63857-2526

Practice Phone: 573-888-1224
Practice Fax: 573-888-3046

1700880788 — TEODORO A MANUBAY M.D.
Practice Location Address:

1312 1ST ST
KENNETT, MO
63857-2526

Practice Phone: 573-888-9823
Practice Fax: 573-888-3046

1851485809 — HARRIS PHARMACY INC.
Practice Location Address:

1224 FIRST ST
KENNETT, MO
63857-2526

Practice Phone: 573-888-6006
Practice Fax:

1548349715 — SEMO DRUGS OF KENNETT INC
Practice Location Address:

1300 1ST ST
KENNETT, MO
63857-2526

Practice Phone: 573-888-8880
Practice Fax: 573-888-3889

1336279645 — HARRIS PHARMACY INC
Practice Location Address:

1224 FIRST STREET
KENNETT, MO
63857-2526

Practice Phone: 573-888-6006
Practice Fax:

1851618011 — KENNETT HMA LLC
Practice Location Address:

1312 1ST ST
KENNETT, MO
63857-2526

Practice Phone: 573-717-1080
Practice Fax: 573-717-1093

Directions to “SEMO DRUG OF KENNETT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.