Healthcare Provider Details

I. General information

NPI: 1033197041
Provider Name (Legal Business Name): CHRISTIAN HEALTH CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 E EVERGREEN ST
SPRINGFIELD MO
65803-4400
US

IV. Provider business mailing address

1328 E EVERGREEN ST
SPRINGFIELD MO
65803-4400
US

V. Phone/Fax

Practice location:
  • Phone: 417-889-6357
  • Fax: 417-823-3870
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2002007189
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ROSENTHAL
Title or Position: PIC
Credential: R.PH.
Phone: 417-889-6357