# HINES STREET PHARMACY 2 LLC

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

## Provider details

- **NPI number:** 1790439842
- **Authorized official:** STEVE MCCLANAHAN (OWNER)
- **Authorized official phone:** (417) 735-0055

## Contact information

- **Practice address:** 1173 E HINES ST, REPUBLIC, MO 65738-1277
- **Practice address phone:** (417) 735-0055
- **Practice address fax:** (417) 732-1529
- **Mailing address:** 1173 E HINES ST, REPUBLIC, MO 65738-1277
- **Mailing address phone:** (417) 735-0055
- **Mailing address fax:** (417) 732-1529

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/08/2022
- **Last updated:** 08/25/2022