Healthcare Provider Details

I. General information

NPI: 1619927860
Provider Name (Legal Business Name): JOHN S RX LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 INDEPENDENCE ST
CAPE GIRARDEAU MO
63703-5805
US

IV. Provider business mailing address

2003 INDEPENDENCE ST
CAPE GIRARDEAU MO
63703-5805
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-4004
  • Fax: 573-651-6074
Mailing address:
  • Phone: 573-651-4004
  • Fax: 573-651-6074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2015041871
License Number StateMO

VIII. Authorized Official

Name: JOHN MCMULLIN
Title or Position: PARTNER
Credential:
Phone: 573-334-1300