Healthcare Provider Details

I. General information

NPI: 1568575033
Provider Name (Legal Business Name): TWIN CITY PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NORTH 1ST
MARBLE HILL MO
63764
US

IV. Provider business mailing address

PO BOX 739 106 N FIRST ST
MARBLE HILL MO
63764-0739
US

V. Phone/Fax

Practice location:
  • Phone: 573-238-4177
  • Fax: 573-238-4986
Mailing address:
  • Phone: 573-238-4177
  • Fax: 573-238-4986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10044744
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number005585
License Number StateMO

VIII. Authorized Official

Name: MR. BRYAN THOMAS KIEFER
Title or Position: PHARMACIST / OWNER
Credential: RPH
Phone: 573-238-4177