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General NPI Number Information
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NPI Number | 1316614001
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Entity Type | Organization
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Legal Business Name | SIKESTON PHARMACY LLC
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 507 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-2105
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Country | US
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Telephone | 573-471-4401
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Fax | 573-471-5448
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Provider Business Mailing Address
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Address Line | 507 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-2105
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Country | US
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Telephone | 573-471-4401
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Fax | 573-471-5448
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | CASEY DUNCAN
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Credential |
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Telephone | 573-576-6562
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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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