Healthcare Provider Details

I. General information

NPI: 1417534512
Provider Name (Legal Business Name): PARKLAND APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 N DESLOGE DR
DESLOGE MO
63601-2936
US

IV. Provider business mailing address

1131 N DESLOGE DR
DESLOGE MO
63601-2936
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-6677
  • Fax: 573-431-3833
Mailing address:
  • Phone: 573-431-6677
  • Fax: 573-431-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH ANN HAMBY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 573-431-6677