Healthcare Provider Details

I. General information

NPI: 1245392133
Provider Name (Legal Business Name): MCWHIRT-GIBSON INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S INGRAM AVE
SEDALIA MO
65301-7536
US

IV. Provider business mailing address

1700 S INGRAM AVE
SEDALIA MO
65301-7536
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-2626
  • Fax: 660-826-4329
Mailing address:
  • Phone: 660-826-2626
  • Fax: 660-826-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number005615
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN KNORP
Title or Position: OWNER
Credential:
Phone: 660-826-2626