Healthcare Provider Details

I. General information

NPI: 1831258839
Provider Name (Legal Business Name): TOWN AND COUNTRY GROCERS OF FREDERICKTOWN MO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 T J STEWART DR
PARK HILLS MO
63601-2500
US

IV. Provider business mailing address

301 T J STEWART DR
PARK HILLS MO
63601-2500
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-8537
  • Fax: 573-431-2514
Mailing address:
  • Phone: 573-431-8537
  • Fax: 573-431-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2006035969
License Number StateMO

VIII. Authorized Official

Name: BOBBIE JOE HUFFORD
Title or Position: OWNER PRESIDENT
Credential:
Phone: 573-783-5703