Healthcare Provider Details

I. General information

NPI: 1841346269
Provider Name (Legal Business Name): FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N STURGEON ST
MONTGOMERY CITY MO
63361-1426
US

IV. Provider business mailing address

806 N STURGEON ST
MONTGOMERY CITY MO
63361-1426
US

V. Phone/Fax

Practice location:
  • Phone: 573-564-2273
  • Fax: 573-564-5249
Mailing address:
  • Phone: 573-564-2273
  • Fax: 573-564-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4995
License Number StateMO

VIII. Authorized Official

Name: MR. JOHN B HOLTMAN
Title or Position: PARTNER
Credential:
Phone: 573-564-2272