Old Town Pharmacy
LBN: Old Town Pharmacy Llc
Old Town Pharmacy is an health care organization with primary practice located at 100A Chapel Drive , Monett MO 65708. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Community/Retail Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Old Town Pharmacy Llc can be contacted via phone (417) 635-1100, or through Becker, Shane Michael via phone (417) 635-1100.
Contact Information
Primary practice address
100A Chapel Drive
Monett MO 65708
Phone: (417) 635-1100
Fax: (417) 635-1103
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 2007022497 | Missouri |
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 2014010847 | Missouri |
| Suppliers / Long Term Care Pharmacy | 3336L0003X |
Profile Details
| NPI number | 1578754701 |
|---|---|
| LBN Legal business name | Old Town Pharmacy Llc |
| DBA Doing business as | Old Town Pharmacy |
| Authorized official | Becker, Shane Michael PHARMD RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Aug 5th, 2007 |
| Last updated | Jun 4th, 2024 - about 2 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578754701 | NPPES |
| Missouri | Other | 2007022497 | PHARMACY LIC |
| Missouri | MEDICAID | 19735928 | PHARMACY LIC |
| Missouri | Other | 2637506 | PHARMACY LIC |
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