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General NPI Number Information
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NPI Number | 1427199090
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Entity Type | Organization
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Legal Business Name | HEALTH CARE PHARMACY OF PERRYVILLE, LLC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 628 OLD SAINT MARYS RD
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City | PERRYVILLE
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State | MO
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Zip | 63775-1837
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Country | US
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Telephone | 573-547-2517
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Fax | 573-547-7758
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Provider Business Mailing Address
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Address Line | 628 N. OLD ST. MARYS ROAD
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City | PERRYVILLE
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State | MO
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Zip | 63775
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Country | US
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Telephone | 573-547-2517
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Fax | 573-547-7758
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Authorized Official
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Title or Position | MANAGER
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Name | MS. SAVANNA GROGG
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Credential |
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Telephone | 573-535-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2017038581
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License Number State | MO
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