Healthcare Provider Details

I. General information

NPI: 1740364850
Provider Name (Legal Business Name): PUXICO PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E. RICHARDSON AVE
PUXICO MO
63960
US

IV. Provider business mailing address

2001 INDEPENDENCE ST
CAPE GIRARDEAU MO
63703-5805
US

V. Phone/Fax

Practice location:
  • Phone: 573-222-6206
  • Fax: 573-222-6406
Mailing address:
  • Phone: 573-222-6206
  • Fax: 573-222-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number042607
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateMO

VIII. Authorized Official

Name: ABRAHAM FUNK
Title or Position: PRESIDENT/OWNER
Credential: PHARMD
Phone: 573-222-6206