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Organization
HINES STREET PHARMACY 2 LLC
Active
Organization
HINES STREET PHARMACY 2 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE MCCLANAHAN (OWNER)
(417) 735-0055
Entity
Organization
Contact information
Practice address
1173 E HINES ST, REPUBLIC, MO 65738-1277
(417) 735-0055
(417) 732-1529
Mailing address
1173 E HINES ST, REPUBLIC, MO 65738-1277
(417) 735-0055
(417) 732-1529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
Other
Enumeration date
02/08/2022
Last updated
08/25/2022
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