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Organization
LA PLATA PHARMACY LLC
Active
Organization
LA PLATA PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE PROKUP (OWNER)
(660) 346-0449
Entity
Organization
Contact information
Practice address
221 N MACON ST, BEVIER, MO 63532-1058
(660) 346-0449
(660) 773-5529
Mailing address
221 N. MACON STREET, BEVIER, MO 63532
(660) 346-0449
(660) 773-5529
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
2018004056
MO
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175841
PK
—
05
—
600133003
—
MO
Enumeration date
02/12/2018
Last updated
04/20/2018
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