Organization
MNM PHARMACY, LLC
Active
Other names
CABOOL DRUG AND DIME
Organization subpart
No
Provider details
NPI number
Authorized official
MIKA LINDSEY (MANAGING MEMBER)
(417) 962-3133
Entity
Organization
Contact information
Practice address
518 MAIN ST, CABOOL, MO 65689-8104
(417) 962-3133
(417) 962-5393
Mailing address
518 MAIN ST, CABOOL, MO 65689-8104
(417) 962-3133
(417) 962-5393
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2016004609
MO
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159160
PK
—
05
—
600662001
—
MO
Enumeration date
01/19/2006
Last updated
10/30/2019
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