# CAMDENTON MEDICAL CENTER PHARMACY

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

## Provider details

- **NPI number:** 1558492421
- **Authorized official:** RONALD GENE HOLMAN RPH (PHARMACIST IN CHARGE)
- **Authorized official phone:** (573) 346-2300

## Contact information

- **Practice address:** 1930 NORTH STATE HWY 5, UNIT 1C, CAMDENTON, MO 65020-1930
- **Practice address phone:** (573) 346-2300
- **Practice address fax:** (573) 346-8409
- **Mailing address:** 1930 NORTH STATE HWY 5, UNIT 1C, CAMDENTON, MO 65020-1930
- **Mailing address phone:** (573) 346-2300
- **Mailing address fax:** (573) 346-8409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 028456 | MO | Yes |

## Other

- **Enumeration date:** 03/09/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2629422 | NABP | MO |
| 01 | — | 29193 | BNDD | MO |