Organization
MAIN STREET PHARMACY LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERA S JOHNSON (MANAGER)
(573) 649-9229
Entity
Organization
Contact information
Practice address
117 E MAIN ST, EAST PRAIRIE, MO 63845-1136
(573) 649-9229
(573) 649-9230
Mailing address
117 E MAIN ST, EAST PRAIRIE, MO 63845-1136
(573) 649-9229
(573) 649-9230
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
625420401
—
MO
Enumeration date
11/09/2005
Last updated
01/02/2013
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