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Organization
FAMILY PHARMACY OF MOUNTAIN GROVE LLC
Active
Organization
FAMILY PHARMACY OF MOUNTAIN GROVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE MICHELLE COFFMAN (OWNER/PHARMACIST)
(417) 926-4156
Entity
Organization
Contact information
Practice address
1600 N MAIN ST, MOUNTAIN GROVE, MO 65711-1010
(417) 926-9655
(417) 926-0045
Mailing address
1600 N MAIN ST, MOUNTAIN GROVE, MO 65711-1010
(417) 926-9655
(417) 926-0045
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
200059684
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
605201201
—
MO
05
—
625201207
—
MO
Enumeration date
02/22/2007
Last updated
11/18/2024
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