# ST. JOHN'S CLINIC INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** St. John's Pharmacy-Rolla
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043308497
- **Authorized official:** MR. ROB D SHOCKLEY RPH (RETAIL PHARMACY COORDINATOR)
- **Authorized official phone:** (417) 820-6624

## Contact information

- **Practice address:** 1100 WEST 10TH STREET, SUITE 150, ROLLA, MO 65401
- **Practice address phone:** (573) 426-4931
- **Practice address fax:** (573) 426-4932
- **Mailing address:** 1100 WEST 10TH STREET, SUITE 150, ROLLA, MO 65401
- **Mailing address phone:** (573) 426-4931
- **Mailing address fax:** (573) 426-4932

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 2006027507 | MO | Yes |

## Other

- **Enumeration date:** 10/11/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | PENDING | — | MO |