Organization
GANT PHARMACY SERVICES INC
Active
Parent organization
GANT PHARMACY SERVICES INC
Other names
Burton Creek Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
GANT PHARMACY SERVICES INC
Authorized official
RUSSELL GANT (OWNER/PIC)
(417) 256-2274
Entity
Organization
Contact information
Practice address
805 N KENTUCKY AVE STE 2, WEST PLAINS, MO 65775-2045
(417) 256-2274
(417) 256-1036
Mailing address
805 N KENTUCKY AVE STE 2, WEST PLAINS, MO 65775-2045
(417) 256-2274
(417) 256-1036
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600305510
—
MO
Enumeration date
12/12/2017
Last updated
12/12/2017
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