Organization
STEPHENS PHARMACY INC
Active
Other names
STEPHENS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHEAL STEPHENS RPH (PHARMACY OWNER)
(417) 326-2416
Entity
Organization
Contact information
Practice address
1100 S SPRINGFIELD AVE, BOLIVAR, MO 65613-2512
(417) 326-2416
(417) 326-6625
Mailing address
1100 S SPRINGFIELD AVE, BOLIVAR, MO 65613-2512
(417) 326-2416
(417) 326-6625
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
006309
MO
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2049470
PK
—
05
—
600749006
—
MO
05
—
620749002 DME
—
MO
Enumeration date
08/10/2006
Last updated
06/22/2015
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