Healthcare Provider Details

I. General information

NPI: 1689062770
Provider Name (Legal Business Name): RINNE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEER LICK ST
LICKING MO
65542-9081
US

IV. Provider business mailing address

PO BOX 495
LICKING MO
65542-0495
US

V. Phone/Fax

Practice location:
  • Phone: 573-674-2995
  • Fax: 573-674-3001
Mailing address:
  • Phone: 573-674-2995
  • Fax: 573-674-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2014043698
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEREMY RINNE
Title or Position: OWNER/PIC
Credential: PHARMD
Phone: 417-350-4619