Healthcare Provider Details

I. General information

NPI: 1366704876
Provider Name (Legal Business Name): PARKLAND PHARMACY DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 E HIGHWAY 72 BYP
FREDERICKTOWN MO
63645-7326
US

IV. Provider business mailing address

1025 E HIGHWAY 72 BYP
FREDERICKTOWN MO
63645-7326
US

V. Phone/Fax

Practice location:
  • Phone: 573-783-6000
  • Fax: 573-783-6008
Mailing address:
  • Phone: 573-783-6000
  • Fax: 573-783-6008

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2012034351
License Number StateMO

VIII. Authorized Official

Name: JEREMY LEACH
Title or Position: OWNER
Credential: RPH
Phone: 573-783-6000