MEDICARE: PARKLAND PHARMACY DEVELOPMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	2012034351	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2161997	OTHER		PK

General Provider Information

NPI Number	:	1053764571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKLAND PHARMACY DEVELOPMENT LLC

Provider Business Mailing Address
First Line	:	1025 E HIGHWAY 72 BYP
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-7326
Country	:	US
Telephone Number	:	573-783-6000
Fax Number	:	573-783-6008

Provider Business Practice Location Address
First Line	:	1025 E HIGHWAY 72 BYP
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-7326
Country	:	US
Telephone Number	:	573-783-6000
Fax Number	:	573-783-6008

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	DEBBIE HAMBY
Credential	:
Telephone Number	:	573-783-6000

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	01/25/2025

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