Organization
TOWN & COUNTRY SUPER MARKET INC
Active
Parent organization
TOWN & COUNTRY SUPER MARKET INC
Other names
Country Mart Pharmacy #2416
Organization subpart
Yes
Provider details
NPI number
Legal business name
TOWN & COUNTRY SUPER MARKET INC
Authorized official
MRS. JANET GOTT RPH (PHARMACY SUPERVISOR)
(573) 729-4091
Entity
Organization
Contact information
Practice address
508 E 5TH ST, DIXON, MO 65459-6201
(573) 759-3073
(573) 759-3560
Mailing address
PO BOX 748, SALEM, MO 65560-0748
(573) 729-4091
(573) 729-2394
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
2005015586
MO
3336C0003X
Community/Retail Pharmacy
Primary
2005015586
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
606197705
—
MO
05
—
626197701
—
MO
Enumeration date
11/08/2005
Last updated
12/04/2012
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