MEDICARE: QUEEN CITY PHARMACIES, 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	332B00000X	Durable Medical Equipment & Medical Supplies		MO
2	333600000X	Pharmacy	005536	MO
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy
5	3336C0003X	Community/Retail Pharmacy	201703117D	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2628494	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770655391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEEN CITY PHARMACIES, LLC

Provider Business Mailing Address
First Line	:	811 E. DIVISION STREET
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-3114
Country	:	US
Telephone Number	:	417-866-3054
Fax Number	:	417-866-1250

Provider Business Practice Location Address
First Line	:	811 E. DIVISION STREET
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-3114
Country	:	US
Telephone Number	:	417-866-3054
Fax Number	:	417-866-1250

Authorized Official
Title or Position	:	MANAGER/MEMBER
Name	:	MR. ERIC J SCHREIBER
Credential	:
Telephone Number	:	612-965-5506

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	03/07/2023

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Directions to “QUEEN CITY PHARMACIES, LLC ” Practice Location

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