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Contact Information

OLD TOWN PHARMACY LLC
100A CHAPEL DRIVE
MONETT, MO65708
 Phone: 417-635-1100
 Fax: 417-635-1103
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for OLD TOWN PHARMACY LLC

NPI Number 1578754701
LBN Legal business name OLD TOWN PHARMACY LLC
Authorized official SHANE BECKER - (OWNER/MANAGER/PIC)
Entity Organization
Organization subpart 1 No
Enumeration date 08/05/2007
Last updated 06/04/2024 - About 2 years ago
Identifiers
MO License # 2007022497
MO License # 2014010847
MO Medicaid 19735928
Other 2637506 NCPDP
MO Other 2007022497 PHARMACY LIC
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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