Organization
ODESSA FAMILY PHARMACY
Active
Other names
ODESSA FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHA DIRCK RPH (OWNER)
(816) 633-8480
Entity
Organization
Contact information
Practice address
316 W 40 HWY, STE A, ODESSA, MO 64076
(816) 633-8480
(816) 230-5675
Mailing address
PO BOX 108, ODESSA, MO 64076-0108
(816) 633-8480
(816) 230-5675
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
004338
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2615194
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600748503 MO
—
MO
Enumeration date
06/10/2006
Last updated
12/23/2011
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