Organization
BROADWAY LTC, LLC
Active
Other names
Broadway Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN WOOD (DIRECTOR OF PHARMACY)
(573) 576-3029
Entity
Organization
Contact information
Practice address
37 DOCTORS PARK STE 7, CAPE GIRARDEAU, MO 63703
(573) 803-2040
Mailing address
710 BROADWAY ST, CAPE GIRARDEAU, MO 63701-5514
(573) 335-8207
(573) 335-4904
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PS2014040344
MO
Other
Enumeration date
11/24/2014
Last updated
07/24/2018
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