Healthcare Provider Details

I. General information

NPI: 1619082658
Provider Name (Legal Business Name): E & S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 WALNUT ST
DONIPHAN MO
63935-1339
US

IV. Provider business mailing address

1105 WALNUT ST
DONIPHAN MO
63935-1339
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-7157
  • Fax: 573-996-7526
Mailing address:
  • Phone: 573-996-7157
  • Fax: 573-996-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number004301
License Number StateMO

VIII. Authorized Official

Name: SANDRA BATES
Title or Position: CHIEF PHARMACIST/CORPORATE SECRETAR
Credential: RPH
Phone: 573-996-7157