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General NPI Number Information
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NPI Number | 1144332149
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Entity Type | Organization
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Legal Business Name | MEDICINE SHOPPE
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 600 PARK LN PARK CENTER SHOPPING CENTER
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-1566
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Country | US
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Telephone | 660-707-0080
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Fax | 660-707-0877
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Provider Business Mailing Address
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Address Line | 600 PARK LN PARK CENTER SHOPPING CENTER
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-1566
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | DIANE WASINGER
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Credential | RPH
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Telephone | 660-707-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2003006242
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License Number State | MO
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