Organization
SOUTHEAST HEALTH PHARMACY LLC
Active
Other names
SoutheastHEALTH Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE MCAFEE (PIC)
(573) 778-1608
Entity
Organization
Contact information
Practice address
2002 KANELL BLVD, STE 102, POPLAR BLUFF, MO 63901-4045
(573) 778-1608
(573) 778-1645
Mailing address
PO BOX 989, POPLAR BLUFF, MO 63902-0989
(573) 778-1608
(573) 778-1645
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2013001184
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140112
PK
—
Enumeration date
04/29/2013
Last updated
02/03/2016
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