Healthcare Provider Details

I. General information

NPI: 1053425025
Provider Name (Legal Business Name): ASH GROVE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 N MEDICAL DR
ASH GROVE MO
65604-1004
US

IV. Provider business mailing address

490 N MEDICAL DR PO BOX 417
ASH GROVE MO
65604-1004
US

V. Phone/Fax

Practice location:
  • Phone: 417-751-2111
  • Fax: 417-751-3112
Mailing address:
  • Phone: 417-751-2111
  • Fax: 417-751-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number004465
License Number StateMO

VIII. Authorized Official

Name: WHITNEY GROVE
Title or Position: PRES
Credential:
Phone: 417-751-2111