Healthcare Provider Details

I. General information

NPI: 1821264433
Provider Name (Legal Business Name): LANDRUM DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2008
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E MOUNT VERNON BLVD
MOUNT VERNON MO
65712-2040
US

IV. Provider business mailing address

106 E MOUNT VERNON BLVD
MOUNT VERNON MO
65712-2040
US

V. Phone/Fax

Practice location:
  • Phone: 417-461-1100
  • Fax: 417-461-1103
Mailing address:
  • Phone: 417-461-1100
  • Fax: 417-461-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2008012584
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JILL FREITAS
Title or Position: OWNER/PIC/SECRETARY
Credential: RPH
Phone: 417-461-1100