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General NPI Number Information
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NPI Number | 1013089804
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Entity Type | Organization
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Legal Business Name | QUEEN CITY PHARMACIES, LLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 1474 N BOONVILLE AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65802-1806
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Country | US
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Telephone | 417-869-1866
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Fax | 417-869-6601
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Provider Business Mailing Address
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Address Line | 1474 N BOONVILLE AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65802-1806
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Country | US
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Telephone | 417-869-1866
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Fax | 417-869-6601
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | REBEKAH ANN ROSE
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Credential |
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Telephone | 417-881-8841
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 006537
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2017031169
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License Number State | MO
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