Healthcare Provider Details

I. General information

NPI: 1508270802
Provider Name (Legal Business Name): NEW MADRID PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 MAIN ST
NEW MADRID MO
63869-1739
US

IV. Provider business mailing address

PO BOX 35
NEW MADRID MO
63869-0035
US

V. Phone/Fax

Practice location:
  • Phone: 573-748-3080
  • Fax: 573-748-2000
Mailing address:
  • Phone: 573-748-3080
  • Fax: 573-748-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2014030752
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES SMALL
Title or Position: PRESIDENT/OWNER
Credential: PHARMD
Phone: 573-748-3080