| NPI | 1891897815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN THOMAS KIEFER Manager / PIC 573-243-3525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MO 005586) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 10119701) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO 10119701) | |
| 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: MO 005586) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2019-04-29 |