MEDICARE: GAINESVILLE PHARMACY LLC

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	183500000X	Pharmacist

General Provider Information

NPI Number	:	1386608602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAINESVILLE PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 856
Second Line	:
City	:	GAINESVILLE
State	:	MO
Zip	:	65655-0856
Country	:	US
Telephone Number	:	417-679-3511
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 W. HWY 160
Second Line	:
City	:	GAINESVILLE
State	:	MO
Zip	:	65655
Country	:	US
Telephone Number	:	417-679-3511
Fax Number	:	417-679-4530

Authorized Official
Title or Position	:	PHARMACIST
Name	:	G BAKER
Credential	:
Telephone Number	:	417-679-3511

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	08/22/2020

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