Organization
SAM'S PRESCRIPTION SHOP, INC.
Active
Other names
Sam's Health Mart Pharmacies
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN S TADRUS (OFFICER)
(660) 263-3309
Entity
Organization
Contact information
Practice address
300 N. MORLEY STREET, MOBERLY, MO 65270
(660) 263-0909
(660) 263-2124
Mailing address
PO BOX 957, MOBERLY, MO 65270-0957
(660) 263-3309
(660) 263-3514
Taxonomy
Speciality
Code
Description
License number
State
208U00000X
Clinical Pharmacology Physician
—
—
291U00000X
Clinical Medical Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332S00000X
Hearing Aid Equipment
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10735224
MISSOURI TAX ID NUMBER
MO
01
—
MA3507
MEDICARE MASS IMMUNIZATION BILLING NUMBER
—
Enumeration date
11/15/2018
Last updated
08/24/2022
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