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General NPI Number Information
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NPI Number | 1063927010
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Entity Type | Organization
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Legal Business Name | GANT PHARMACY SERVICES INC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 805 N KENTUCKY AVE STE 2
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City | WEST PLAINS
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State | MO
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Zip | 65775-2045
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Country | US
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Telephone | 417-256-2274
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Fax | 417-256-1036
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Provider Business Mailing Address
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Address Line | 805 N KENTUCKY AVE STE 2
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City | WEST PLAINS
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State | MO
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Zip | 65775-2045
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Country | US
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Telephone | 417-256-2274
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Fax | 417-256-1036
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Authorized Official
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Title or Position | OWNER/PIC
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Name | RUSSELL GANT
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Credential |
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Telephone | 417-256-2274
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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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