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General NPI Number Information
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NPI Number | 1003102153
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Entity Type | Organization
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Legal Business Name | THE OTHER SIDE HOME HEALTH EQUIPMENT AND SUPPLY
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 909 W PINE ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-4958
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Country | US
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Telephone | 573-785-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 909 W PINE ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-4958
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Country | US
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Telephone | 573-785-4300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEANA CHALIGOJ
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Credential |
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Telephone | 573-785-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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