Healthcare Provider Details

I. General information

NPI: 1619982246
Provider Name (Legal Business Name): COLE CAMP PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S MAPLE ST
COLE CAMP MO
65325-1120
US

IV. Provider business mailing address

PO BOX 100
COLE CAMP MO
65325-0100
US

V. Phone/Fax

Practice location:
  • Phone: 660-668-4646
  • Fax: 660-668-4633
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006476
License Number StateMO

VIII. Authorized Official

Name: MICHAEL SNELL
Title or Position: OWNER
Credential:
Phone: 660-668-4646