MEDICARE: SAMS PRESCRIPTION SHOP INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336S0011X	Specialty Pharmacy
5	3336C0003X	Community/Retail Pharmacy	003205	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2049295	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568453397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMS PRESCRIPTION SHOP INC

Provider Business Mailing Address
First Line	:	PO BOX 957
Second Line	:	(26-08872)
City	:	MOBERLY
State	:	MO
Zip	:	65270-0957
Country	:	US
Telephone Number	:	660-263-3309
Fax Number	:	660-263-3514

Provider Business Practice Location Address
First Line	:	300 N MORLEY ST
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-2334
Country	:	US
Telephone Number	:	660-263-0909
Fax Number	:	660-263-2124

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTIAN TADRUS
Credential	:
Telephone Number	:	660-263-3309

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	08/24/2022

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Directions to “SAMS PRESCRIPTION SHOP INC ” Practice Location

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