Healthcare Provider Details

I. General information

NPI: 1386608602
Provider Name (Legal Business Name): GAINESVILLE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W. HWY 160
GAINESVILLE MO
65655
US

IV. Provider business mailing address

PO BOX 856
GAINESVILLE MO
65655-0856
US

V. Phone/Fax

Practice location:
  • Phone: 417-679-3511
  • Fax: 417-679-4530
Mailing address:
  • Phone: 417-679-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: G BAKER
Title or Position: PHARMACIST
Credential:
Phone: 417-679-3511