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NPI Code Detail

MEDICARE: CARROLL CNTY MEM HOSP PHARMACY INC

MEDICARE: CARROLL CNTY MEM HOSP 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
13336I0012XInstitutional Pharmacy
23336I0012XInstitutional Pharmacy21044MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12623266OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942316708
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARROLL CNTY MEM HOSP PHARMACY INC
Provider Business Mailing Address
First Line : 1502 N JEFFERSON ST
Second Line :
City : CARROLLTON
State : MO
Zip : 64633-1948
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1502 N JEFFERSON ST
Second Line :
City : CARROLLTON
State : MO
Zip : 64633-1948
Country : US
Telephone Number : 660-542-1695
Fax Number : 660-542-0363
Authorized Official
Title or Position : CEO
Name : JERRY DOVER
Credential :
Telephone Number : 660-542-1695
Provider Enumeration Date : 08/22/2006
Last Update Date : 08/22/2020

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Directions to “CARROLL CNTY MEM HOSP PHARMACY INC ” Practice Location

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