Healthcare Provider Details

I. General information

NPI: 1063513398
Provider Name (Legal Business Name): CARTHAGE PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E MOUNT VERNON BLVD
MOUNT VERNON MO
65712-9100
US

IV. Provider business mailing address

PO BOX 68
MOUNT VERNON MO
65712-0068
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-2000
  • Fax: 417-466-2028
Mailing address:
  • Phone: 417-466-2000
  • Fax: 417-466-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2004011847
License Number StateMO

VIII. Authorized Official

Name: CHARLES DAVIN VAUGHN
Title or Position: PRESIDENT/OWNER
Credential: RPH
Phone: 417-461-7777