Healthcare Provider Details

I. General information

NPI: 1316203417
Provider Name (Legal Business Name): MAIN SAIL ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 HIGH ST
SARCOXIE MO
64862-8323
US

IV. Provider business mailing address

1408 HIGH ST
SARCOXIE MO
64862-8323
US

V. Phone/Fax

Practice location:
  • Phone: 417-548-7184
  • Fax: 417-548-7404
Mailing address:
  • Phone: 417-548-7184
  • Fax: 417-548-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHARLES DAVID KERR
Title or Position: MANAGER
Credential: RPH
Phone: 417-548-7184