Healthcare Provider Details

I. General information

NPI: 1134289374
Provider Name (Legal Business Name): HERMANN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 VILLAGE LN
HERMANN MO
65041-1592
US

IV. Provider business mailing address

2060 VILLAGE LN
HERMANN MO
65041-1592
US

V. Phone/Fax

Practice location:
  • Phone: 573-486-8999
  • Fax: 573-486-8998
Mailing address:
  • Phone: 573-486-8999
  • Fax: 573-486-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2004029892
License Number StateMO

VIII. Authorized Official

Name: STEPHEN JOHN
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 573-486-8999