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NPI Code Detail

MEDICARE: COMMUNITY PHARMACY, INC.

MEDICARE: COMMUNITY PHARMACY, 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
1183500000XPharmacist044158MO

Other Identifiers

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

General Provider Information

NPI Number : 1679554406
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY PHARMACY, INC.
Provider Business Mailing Address
First Line : 900 S ADAMS ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-3210
Country : US
Telephone Number : 417-667-6044
Fax Number : 417-667-0544
Provider Business Practice Location Address
First Line : 900 S ADAMS ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-3210
Country : US
Telephone Number : 417-667-6044
Fax Number : 417-667-0544
Authorized Official
Title or Position : PHARMACIST IN CHARGE/MANAGER
Name : MRS. LORI MARIE BARTLETT
Credential : R.PH
Telephone Number : 417-667-6044
Provider Enumeration Date : 11/09/2005
Last Update Date : 02/13/2012

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1356346050 — HEATHER RUSSELL M.D.
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1013081090 — SUMMERS PHARMACY OF NEVADA LLC
Practice Location Address:
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Practice Fax: 417-667-0544

Directions to “COMMUNITY PHARMACY, INC. ” Practice Location

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