Healthcare Provider Details

I. General information

NPI: 1326234329
Provider Name (Legal Business Name): STOCKSTILLS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W MCCLURG AVE
RICHLAND MO
65556
US

IV. Provider business mailing address

PO BOX 310
RICHLAND MO
65556-0310
US

V. Phone/Fax

Practice location:
  • Phone: 573-765-3321
  • Fax: 573-765-5200
Mailing address:
  • Phone: 573-765-3321
  • Fax: 573-765-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2004006519
License Number StateMO

VIII. Authorized Official

Name: DENNIS STOCKSTILL
Title or Position: PRESIDENT
Credential: RPH
Phone: 573-765-3321