Organization
KNL PRESCRIPTIONS LLC
Active
Other names
BROADWAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN WOOD PHARMD (OWNER)
(573) 335-8207
Entity
Organization
Contact information
Practice address
710 BROADWAY ST, CAPE GIRARDEAU, MO 63701-5514
(573) 335-8207
(573) 335-4904
Mailing address
37 DOCTORS PARK # 7, CAPE GIRARDEAU, MO 63703-4956
(573) 803-2040
(573) 335-4904
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2011012280
MO
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2130422
PK
—
05
—
600200208
—
MO
Enumeration date
10/18/2005
Last updated
07/19/2018
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