Organization
AUSTIN PLAZA PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLIE THOMPSON (PRESIDENT)
(573) 768-1529
Entity
Organization
Contact information
Practice address
410 E HIGH ST STE A, POTOSI, MO 63664-1927
(573) 438-2349
(573) 438-8877
Mailing address
410 E HIGH ST STE A, POTOSI, MO 63664-1927
(573) 438-2349
(573) 438-8877
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
002790
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2049323
PK
—
05
—
600095905
—
MO
Enumeration date
09/06/2006
Last updated
01/04/2018
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