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General NPI Number Information
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NPI Number | 1689508673
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Entity Type | Organization
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Legal Business Name | PHELPS COUNTY REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 06/12/2026
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Last Update Date | 06/12/2026
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Provider Practice Location Address
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Address Line | 1050 W 10TH ST, SUITE 100
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City | ROLLA
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State | MO
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Zip | 65401-2905
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Country | US
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Telephone | 573-458-3360
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Fax | 573-458-3362
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Provider Business Mailing Address
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Address Line | 1000 W 10TH ST
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City | ROLLA
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State | MO
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Zip | 65401-2905
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Country | US
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Telephone | 573-458-7892
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Fax |
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Authorized Official
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Title or Position | EXEC DIR 340B & PHARM BUSS STRATEGY
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Name | KREIG L MOORE
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Credential | R.PH., 340ACE
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Telephone | 573-458-7892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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