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General NPI Number Information
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NPI Number | 1164164976
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Entity Type | Organization
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Legal Business Name | ALTENBURG PHARMACY, LLC
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 8491 MAIN ST
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City | ALTENBURG
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State | MO
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Zip | 63732-6169
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Country | US
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Telephone | 573-824-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 INDEPENDENCE ST
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-5805
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Country | US
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Telephone | 573-334-1300
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Fax | 573-334-0493
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Authorized Official
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Title or Position | OWNER
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Name | ABRAHAM FUNK
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Credential | PHARMD
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Telephone | 573-334-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 |
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License Number State |
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