Healthcare Provider Details

I. General information

NPI: 1063927010
Provider Name (Legal Business Name): GANT PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N KENTUCKY AVE STE 2
WEST PLAINS MO
65775-2045
US

IV. Provider business mailing address

805 N KENTUCKY AVE STE 2
WEST PLAINS MO
65775-2045
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-2274
  • Fax: 417-256-1036
Mailing address:
  • Phone: 417-256-2274
  • Fax: 417-256-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL GANT
Title or Position: OWNER/PIC
Credential:
Phone: 417-256-2274