Organization
MOUNTAIN GROVE PHARMACY INC
Active
Other names
MOUNTAIN GROVE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE COFFMAN (PIC)
(417) 926-9655
Entity
Organization
Contact information
Practice address
106 N UNION ST, MOUNTAIN GROVE, MO 65711-1724
(417) 926-4156
(417) 926-4125
Mailing address
106 N UNION ST, MOUNTAIN GROVE, MO 65711-1724
(417) 926-4156
(417) 926-4125
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2015006569
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2049297
PK
—
05
—
601091507
—
MO
Enumeration date
08/10/2006
Last updated
11/26/2024
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