MEDICARE: TWIN CITY PHARMACY, 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	3336L0003X	Long Term Care Pharmacy	005585	MO
2	3336C0003X	Community/Retail Pharmacy	10044744	MO

General Provider Information

NPI Number	:	1568575033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN CITY PHARMACY, INC

Provider Business Mailing Address
First Line	:	PO BOX 739
Second Line	:	106 N FIRST ST
City	:	MARBLE HILL
State	:	MO
Zip	:	63764-0739
Country	:	US
Telephone Number	:	573-238-4177
Fax Number	:	573-238-4986

Provider Business Practice Location Address
First Line	:	106 NORTH 1ST
Second Line	:
City	:	MARBLE HILL
State	:	MO
Zip	:	63764
Country	:	US
Telephone Number	:	573-238-4177
Fax Number	:	573-238-4986

Authorized Official
Title or Position	:	PHARMACIST / OWNER
Name	:	MR. BRYAN THOMAS KIEFER
Credential	:	RPH
Telephone Number	:	573-238-4177

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	06/05/2018

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