Organization
C&P VIBURNUM VENTURES LLC
Active
Other names
Iron County Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
REBECA WALTERS-PEACE (OWNER-RPH)
(417) 778-6807
Entity
Organization
Contact information
Practice address
1 VIBURNUM CENTER RD STE B, VIBURNUM, MO 65566-7802
(573) 244-3784
(573) 244-3700
Mailing address
450 COUNTY ROAD 139, ALTON, MO 65606-8221
(573) 244-3784
(573) 244-3700
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2015037740
MO
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184092793
—
MO
01
—
2154621
PK
—
05
—
600027013
—
MO
Enumeration date
09/14/2015
Last updated
04/27/2023
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