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General NPI Number Information
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NPI Number | 1053712109
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Entity Type | Organization
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Legal Business Name | CITIZENS MEMORIAL HOSPITAL DISTRICT
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 1301-B NORTH OAKLAND
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City | BOLIVAR
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State | MO
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Zip | 65613
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Country | US
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Telephone | 417-326-6003
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Fax | 417-777-5806
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Provider Business Mailing Address
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Address Line | 1500 N OAKLAND AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-3011
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Country | US
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Telephone | 417-326-6003
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Fax | 417-777-5806
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Authorized Official
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Title or Position | CEO
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Name | DONALD BABB
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Credential |
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Telephone | 417-326-6501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care 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 | 2002031104
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License Number State | MO
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