Healthcare Provider Details

I. General information

NPI: 1700979457
Provider Name (Legal Business Name): TOWN & COUNTRY PHARMACIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 SOUTH HOPE ST.
JACKSON MO
63755
US

IV. Provider business mailing address

404 SOUTH HOPE ST.
JACKSON MO
63755
US

V. Phone/Fax

Practice location:
  • Phone: 573-243-3117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2003009590
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2003009590
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier620127308
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 2
Identifier600127302
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: MR. DONALD SCHREIBER
Title or Position: PRESIDENT
Credential:
Phone: 636-227-6962