Organization
BERTONCINO ENTERPRISES INC
Active
Other names
MEDICINE SHOP PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINICK J BERTONCINO RPH (OWNER PHARMACIST)
(417) 673-4909
Entity
Organization
Contact information
Practice address
1107 S MADISON ST STE A, STE A, WEBB CITY, MO 64870-2831
(417) 673-4909
(417) 673-5697
Mailing address
1107 S MADISON ST STE A, STE A, WEBB CITY, MO 64870-2831
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
006106
MO
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2631100
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/03/2006
Last updated
06/18/2008
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