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Organization

TOWN & COUNTRY GROCERS OF FREDERICKTOWN MD INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JEREMY I LEACH RPH (PHARMACIST-IN-CHARGE)
(573) 783-2788
Entity
Organization

Contact information

Practice address
210 E MURTA ST, FREDERICKTOWN, MO 63645-1018
(573) 783-2788
(573) 783-7899
Mailing address
210 E MURTA ST, FREDERICKTOWN, MO 63645-1018
(573) 783-2788
(573) 783-7899

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
006148
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
621894401
MO
Enumeration date
06/15/2007
Last updated
11/18/2009
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