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General NPI Number Information
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NPI Number | 1326187212
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Entity Type | Organization
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Legal Business Name | ST OF MO FULTON ST HOSP
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 600 E 5TH ST
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City | FULTON
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State | MO
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Zip | 65251-1753
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Country | US
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Telephone | 573-592-3062
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Fax | 573-592-3070
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Provider Business Mailing Address
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Address Line | 600 E 5TH ST
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City | FULTON
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State | MO
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Zip | 65251-1753
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Country | US
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Telephone | 573-592-3062
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Fax | 573-592-3070
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATIVE SERVICES
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Name | MOLLY JANE BOECKMANN
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Credential |
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Telephone | 573-751-4055
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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 | 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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Taxonomy #3
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 001897
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License Number State | MO
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