Healthcare Provider Details

I. General information

NPI: 1700906591
Provider Name (Legal Business Name): SINKS PHARMACY SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100B S BISHOP AVE
ROLLA MO
65401-4418
US

IV. Provider business mailing address

PO BOX 528
CUBA MO
65453-0528
US

V. Phone/Fax

Practice location:
  • Phone: 573-308-4899
  • Fax: 573-308-4893
Mailing address:
  • Phone: 573-308-4899
  • Fax: 573-308-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2005000322
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: LOCAL HEALTH MISSOURI
Title or Position: OWNER
Credential:
Phone: 573-885-0885