MEDICARE: TOWN AND COUNTRY SUPER MARKET , INC

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	3336C0003X	Community/Retail Pharmacy
2	183500000X	Pharmacist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427524594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN AND COUNTRY SUPER MARKET , INC

Provider Business Mailing Address
First Line	:	604-A E. SOUTH ST.
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721
Country	:	US
Telephone Number	:	417-581-7777
Fax Number	:	417-581-3998

Provider Business Practice Location Address
First Line	:	604 E SOUTH ST STE A
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-8912
Country	:	US
Telephone Number	:	417-581-7777
Fax Number	:	417-581-3998

Authorized Official
Title or Position	:	CFO/CORP .SECRETARY
Name	:	DRUSILLA ZOANN HOWARD
Credential	:
Telephone Number	:	573-729-2325

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	06/24/2022

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Directions to “TOWN AND COUNTRY SUPER MARKET , INC ” Practice Location

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