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General NPI Number Information
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NPI Number | 1225142292
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Entity Type | Organization
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Legal Business Name | MUSTANG DRUG INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 704 C SOUTH HWY 59
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City | ANDERSON
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State | MO
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Zip | 64831
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Country | US
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Telephone | 417-845-7799
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Fax | 417-845-7797
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Provider Business Mailing Address
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Address Line | PO BOX 418
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City | ANDERSON
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State | MO
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Zip | 64831-0418
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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 | PRESIDENT
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Name | MICHAEL THORTON
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Credential |
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Telephone | 417-845-7799
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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 | 1999140201
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License Number State | MO
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