| NPI | 1063766335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT J MAXWELL Owner/Pharmacy Manager 573-822-5800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MO 2012038295) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2012-11-07 |