Organization
MIKE STUART ENTERPRISES, INC.
Active
Other names
LAKELAND PHARMACY #7
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL STUART (OWNER/PRESIDENT)
(417) 272-8064
Entity
Organization
Contact information
Practice address
110 BEAR DR STE 4, WILLOW SPRINGS, MO 65793-7103
(417) 469-9009
(417) 469-5005
Mailing address
18565 BUSINESS 13, BRANSON WEST, MO 65737-9659
(417) 272-8064
(417) 272-0073
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
2013004561
MO
3336C0003X
Community/Retail Pharmacy
Primary
2013004561
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2640921
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600005149
—
MO
Enumeration date
02/25/2013
Last updated
06/18/2024
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