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Contact Information

HINES STREET PHARMACY LLC
1173 E HINES ST
REPUBLIC, MO65738-1277
 Phone: 417-735-0055
 Fax: 417-732-1529
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Diabetes Educator

163WD0400X
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for HINES STREET PHARMACY LLC

NPI # 1740559764
LBN Legal business name HINES STREET PHARMACY LLC
Authorized official STEPHEN MCCLANAHAN - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 12/20/2011
Last updated 11/24/2020 - About 6 years ago
Identifiers
MO License # 2012001548
MO Medicaid 609551700
Other 2133471 PK
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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