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
Fax: (417) 635-1103
Website:
Authorized official contact:
Name: Becker, Shane Michael PHARMD RPH

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578754701 NPPES
Missouri Other 2007022497 PHARMACY LIC
Missouri MEDICAID 19735928 PHARMACY LIC
Missouri Other 2637506 PHARMACY LIC

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