=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699187468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OZARK LTC RX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2014
-----------------------------------------------------
Last Update Date | 05/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 BONNEVILLE PLZ
-----------------------------------------------------
City | BONNE TERRE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63628-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-755-0800
-----------------------------------------------------
Fax | 888-305-1276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 BONNEVILLE PLZ
-----------------------------------------------------
City | BONNE TERRE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63628-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-755-0800
-----------------------------------------------------
Fax | 888-305-1276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | SCOTT R MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-319-1450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 2014015500
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------