| NPI | 1134122740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOBY PRATER President 417-776-8701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MO 004976) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2020-10-06 |