Organization
OSAGE PHARMACY, LLC
Active
Other names
Medical Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK T KLEINBECK RPH (PRESIDENT)
(573) 778-6804
Entity
Organization
Contact information
Practice address
513B GRAND AVE, DONIPHAN, MO 63935-1405
(573) 996-3784
(573) 996-5275
Mailing address
2210 BARRON RD, POPLAR BLUFF, MO 63901-1908
(573) 686-4556
(573) 686-4529
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
623809308
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2637051
NCPDP
MO
05
—
603809302
—
MO
Enumeration date
02/06/2007
Last updated
03/07/2023
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