Healthcare Provider Details

I. General information

NPI: 1790879526
Provider Name (Legal Business Name): JOE'S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 S JEFFERSON AVE
LEBANON MO
65536-3261
US

IV. Provider business mailing address

489 S JEFFERSON AVE
LEBANON MO
65536-3261
US

V. Phone/Fax

Practice location:
  • Phone: 417-532-7128
  • Fax: 417-532-9610
Mailing address:
  • Phone: 417-532-7128
  • Fax: 417-532-9610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00268
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN ELIZABETH HILL
Title or Position: PIC
Credential: RPH
Phone: 417-532-7128