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General NPI Number Information
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NPI Number | 1942756465
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Entity Type | Organization
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Legal Business Name | C & P ALTON VENTURES LLC
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 201 STATE HWY 19
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City | ALTON
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State | MO
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Zip | 65606
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Country | US
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Telephone | 417-778-7000
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Fax | 417-778-7005
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Provider Business Mailing Address
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Address Line | 450 COUNTY ROAD 139
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City | ALTON
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State | MO
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Zip | 65606-8221
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Country | US
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Telephone | 417-778-6807
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Fax |
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Authorized Official
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Title or Position | RPH/CO-OWNER
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Name | REBECCA WALTERS-PEACE
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Credential |
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Telephone | 417-778-6807
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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 | 3336C0004X
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Taxonomy Name | Compounding 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2016031074
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License Number State | MO
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