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General NPI Number Information
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NPI Number | 1285774828
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Entity Type | Organization
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Legal Business Name | OSAGE PHARMACY, LLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 513B GRAND AVE
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City | DONIPHAN
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State | MO
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Zip | 63935-1405
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Country | US
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Telephone | 573-996-3784
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Fax | 573-996-5275
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Provider Business Mailing Address
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Address Line | 2210 BARRON RD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-1908
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Country | US
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Telephone | 573-686-4556
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Fax | 573-686-4529
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK T KLEINBECK
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Credential | RPH
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Telephone | 573-778-6804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 623809308
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License Number State | MO
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