# KIMBERLING CITY PHARMACY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316043490
- **Authorized official:** RUDY JOHNSON R. PH (PHARMACIST OWNER)
- **Authorized official phone:** (417) 739-2273

## Contact information

- **Practice address:** 41 KIMBERLING CITY CENTER LANE, KIMBERLING CITY, MO 65686-0908
- **Practice address phone:** (417) 739-2273
- **Practice address fax:** (417) 739-1706
- **Mailing address:** PO BOX 908, 41 KIMBERLING CITY CENTER LANE, KIMBERLING CITY, MO 65686-0908
- **Mailing address phone:** (417) 739-2273
- **Mailing address fax:** (417) 739-1706

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 004551 | MO | Yes |

## Other

- **Enumeration date:** 09/15/2006
- **Last updated:** 10/06/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2622923 | NABP | MO |
| 05 | — | KI602214603 | — | MO |