Organization
SAMS PRESCRIPTION SHOP INC
Active
Other names
Sam's Health Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN TADRUS (OWNER)
(660) 263-3309
Entity
Organization
Contact information
Practice address
300 N CHURCH ST, FAYETTE, MO 65248-1106
(660) 248-2275
(660) 248-2858
Mailing address
PO BOX 957, (26-21907), MOBERLY, MO 65270-0957
(660) 263-3309
(660) 263-3514
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
004390
MO
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050580
PK
—
05
—
600061113
—
MO
Enumeration date
08/31/2006
Last updated
09/14/2020
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