MEDICARE: GOSNEY 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	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	2014043722	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2047522	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962448472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOSNEY PHARMACY INC

Provider Business Mailing Address
First Line	:	911 HIGHWAY 24/36 EAST
Second Line	:
City	:	MONROE CITY
State	:	MO
Zip	:	63456
Country	:	US
Telephone Number	:	573-735-1130
Fax Number	:	573-735-4831

Provider Business Practice Location Address
First Line	:	911 HIGHWAY 24/36 EAST
Second Line	:
City	:	MONROE CITY
State	:	MO
Zip	:	63456
Country	:	US
Telephone Number	:	573-735-1130
Fax Number	:	573-735-4831

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID GOSNEY
Credential	:
Telephone Number	:	573-795-2304

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	02/16/2017

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Directions to “GOSNEY PHARMACY INC ” Practice Location

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