Organization
SAM'S PRESCRIPTION SHOP, INC.
Active
Other names
Sam's Health Mart Pharmacy # 2 (Long-Term Care)
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN TADRUS (OWNER)
(660) 263-3309
Entity
Organization
Contact information
Practice address
530 EAST 24 HIGHWAY, MOBERLY, MO 65270
(660) 263-0615
(660) 263-1541
Mailing address
PO BOX 957, MOBERLY, MO 65270-0957
(660) 263-3309
(660) 263-3514
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
2010042682
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2162343
PK
—
05
—
600202824
—
MO
Enumeration date
08/02/2016
Last updated
08/24/2022
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