Organization
NORTHWEST PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK T KLEINBECK RPH (PRESIDENT)
(573) 686-6211
Entity
Organization
Contact information
Practice address
2210 BARRON RD, POPLAR BLUFF, MO 63901-1908
(573) 686-6211
(573) 686-2219
Mailing address
2210 BARRON RD, POPLAR BLUFF, MO 63901-1908
(573) 686-6211
(573) 686-2219
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
620059725
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902974140
RX NPI
MO
01
—
2004019998
MO PHARMACY PERMIT
MO
05
—
620059725
—
MO
Enumeration date
03/15/2007
Last updated
03/07/2023
Update your record
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