Healthcare Provider Details

I. General information

NPI: 1962116053
Provider Name (Legal Business Name): 6 TURTLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N JEFFERSON ST
SAINT JAMES MO
65559-1917
US

IV. Provider business mailing address

125 N JEFFERSON ST
SAINT JAMES MO
65559-1917
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-5400
  • Fax: 573-265-6006
Mailing address:
  • Phone: 573-265-5400
  • Fax: 573-265-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY WILSON
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 573-263-1235