Healthcare Provider Details

I. General information

NPI: 1659616225
Provider Name (Legal Business Name): SWEET SPRINGS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 N MISSOURI AVE
MARCELINE MO
64658
US

IV. Provider business mailing address

PO BOX 737
CHILLICOTHEE MO
64601-0737
US

V. Phone/Fax

Practice location:
  • Phone: 660-376-2700
  • Fax:
Mailing address:
  • Phone: 660-707-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateMO

VIII. Authorized Official

Name: ANTHONY EUGENE CLARK
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 660-247-1580