Healthcare Provider Details

I. General information

NPI: 1871607846
Provider Name (Legal Business Name): JIMS SCRIPT SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15580 ST HWY 60
FORSYTH MO
65653
US

IV. Provider business mailing address

PO BOX 934
FORSYTH MO
65653-0934
US

V. Phone/Fax

Practice location:
  • Phone: 417-546-5777
  • Fax: 417-546-6142
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4401
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES FREDERICH
Title or Position: OWNER
Credential: RPH
Phone: 417-546-5777