Healthcare Provider Details

I. General information

NPI: 1336187707
Provider Name (Legal Business Name): PAMIDA STORES OPERATING CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W BUCHANAN ST
CALIFORNIA MO
65018-1238
US

IV. Provider business mailing address

1021 W BUCHANAN ST
CALIFORNIA MO
65018-1238
US

V. Phone/Fax

Practice location:
  • Phone: 573-796-8002
  • Fax: 573-796-8004
Mailing address:
  • Phone: 573-796-8002
  • Fax: 573-796-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2006008264
License Number StateMO

VIII. Authorized Official

Name: MR. JOHN HARLOW
Title or Position: CEO/PRESIDENT
Credential:
Phone: 402-596-7206