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General NPI Number Information
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NPI Number | 1851957955
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Entity Type | Organization
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Legal Business Name | MAIN STREET MEDICAL PHARMACY, LLC
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 403 S MAIN ST
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City | GALLATIN
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State | MO
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Zip | 64640-1434
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Country | US
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Telephone | 660-663-7979
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Fax | 660-663-2963
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Provider Business Mailing Address
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Address Line | 403 S MAIN ST
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City | GALLATIN
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State | MO
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Zip | 64640-1434
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Country | US
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Telephone | 660-663-7979
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Fax | 660-663-2963
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Authorized Official
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Title or Position | OWNER, PIC
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Name | DR. NICOLE MCHARGUE NEAL
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Credential | PHARMD
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Telephone | 660-663-7979
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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 |
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License Number State |
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