Organization
BROADWAY LTC, LLC
Active
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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