MEDICARE: GARDNER PHARMACY SERVICES 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	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336M0002X	Mail Order Pharmacy
4	3336C0003X	Community/Retail Pharmacy	2001021786	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2048722	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639126139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDNER PHARMACY SERVICES INC

Provider Business Mailing Address
First Line	:	712 S MAIN ST
Second Line	:
City	:	BROOKFIELD
State	:	MO
Zip	:	64628-2307
Country	:	US
Telephone Number	:	660-258-2122
Fax Number	:	660-258-7338

Provider Business Practice Location Address
First Line	:	712 S MAIN ST
Second Line	:
City	:	BROOKFIELD
State	:	MO
Zip	:	64628-2307
Country	:	US
Telephone Number	:	660-258-2122
Fax Number	:	660-258-7338

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	DAVID GARDNER
Credential	:
Telephone Number	:	660-258-2122

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	09/19/2025

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Directions to “GARDNER PHARMACY SERVICES INC ” Practice Location

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