Organization
KB KIRKSVILLE PHARMACY LLC
Active
Other names
KIRKSVILLE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY TIMMERMANN RPH (MANAGER/AO)
(417) 876-3313
Entity
Organization
Contact information
Practice address
1611 S BALTIMORE ST, KIRKSVILLE, MO 63501-4518
(660) 956-7010
(660) 956-7015
Mailing address
1611 S BALTIMORE ST, STE B, KIRKSVILLE, MO 63501-4518
(660) 956-7010
(660) 956-7015
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2016029935
MO
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160612
PK
—
05
—
600035560
—
MO
Enumeration date
06/13/2016
Last updated
04/02/2020
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