Healthcare Provider Details

I. General information

NPI: 1861638314
Provider Name (Legal Business Name): JMC PHARMACIES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 E ROCKHURST ST STE 108
SPRINGFIELD MO
65802-6501
US

IV. Provider business mailing address

2103 E ROCKHURST ST STE 108
SPRINGFIELD MO
65802-6522
US

V. Phone/Fax

Practice location:
  • Phone: 417-864-5873
  • Fax: 417-864-5874
Mailing address:
  • Phone: 417-864-5873
  • Fax: 417-864-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2009000059
License Number StateMO

VIII. Authorized Official

Name: MICHAEL COUNTS
Title or Position: MANAGER
Credential:
Phone: 417-894-8144