Healthcare Provider Details

I. General information

NPI: 1629176037
Provider Name (Legal Business Name): HIXSON DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604A E SOUTH ST
OZARK MO
65721-8912
US

IV. Provider business mailing address

604A E SOUTH ST PO BOX 459
OZARK MO
65721-8912
US

V. Phone/Fax

Practice location:
  • Phone: 417-581-7777
  • Fax: 417-581-8152
Mailing address:
  • Phone: 417-581-7777
  • Fax: 417-581-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number5042
License Number StateMO

VIII. Authorized Official

Name: MR. CARL HEFNER
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 417-581-7777