Healthcare Provider Details

I. General information

NPI: 1780059378
Provider Name (Legal Business Name): BATES COUNTY MEMORIAL HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W NURSERY ST
BUTLER MO
64730-1840
US

IV. Provider business mailing address

615 W NURSERY ST
BUTLER MO
64730-1840
US

V. Phone/Fax

Practice location:
  • Phone: 660-200-7032
  • Fax: 660-200-7031
Mailing address:
  • Phone: 660-200-7032
  • Fax: 660-200-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number005364
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK JONES
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 660-200-7032