Healthcare Provider Details

I. General information

NPI: 1548349715
Provider Name (Legal Business Name): SEMO DRUGS OF KENNETT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 1ST ST
KENNETT MO
63857-2526
US

IV. Provider business mailing address

1300 1ST ST
KENNETT MO
63857-2526
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-8880
  • Fax: 573-888-3889
Mailing address:
  • Phone: 573-888-8880
  • Fax: 573-888-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006018
License Number StateMO

VIII. Authorized Official

Name: DR. JENNA HAWKINS
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 573-888-8880