Organization
COURT SQUARE PHARMACY, INC
Active
Other names
THEODOSIA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG ATKINS (PIC)
(417) 679-2650
Entity
Organization
Contact information
Practice address
4900 US HIGHWAY 160 STE 1, THEODOSIA, MO 65761-6539
(417) 273-4555
(417) 273-4559
Mailing address
PO BOX 353, THEODOSIA, MO 65761-0353
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2004008518
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2049026
PK
—
05
—
606130102
—
MO
Enumeration date
12/14/2006
Last updated
02/20/2017
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