Organization
TOWN & COUNTRY GROCERS OF FREDERICKTOWN MO INC
Active
Other names
COUNTRY MART PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BROWN (SUPERVISOR)
(573) 783-5703
Entity
Organization
Contact information
Practice address
50 BERRY RD, BONNE TERRE, MO 63628-1373
(573) 358-0099
(573) 358-0084
Mailing address
50 BERRY RD, BONNE TERRE, MO 63628-1373
(573) 358-0099
(573) 358-0084
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
006162
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2047644
PK
—
05
—
608853404
—
MO
Enumeration date
11/27/2006
Last updated
03/23/2017
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