Healthcare Provider Details

I. General information

NPI: 1427524594
Provider Name (Legal Business Name): TOWN AND COUNTRY SUPER MARKET , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E SOUTH ST STE A
OZARK MO
65721-8912
US

IV. Provider business mailing address

604-A E. SOUTH ST.
OZARK MO
65721
US

V. Phone/Fax

Practice location:
  • Phone: 417-581-7777
  • Fax: 417-581-3998
Mailing address:
  • Phone: 417-581-7777
  • Fax: 417-581-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: DRUSILLA ZOANN HOWARD
Title or Position: CFO/CORP .SECRETARY
Credential:
Phone: 573-729-2325