Organization
OVERTURF DRUG STORES OF DEXTER, INC.
Active
Other names
OVERTURF PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BOONE (DIRECTOR OF HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
903 WEST BUSINESS HWY 60, DEXTER, MO 63841
(573) 624-6968
(573) 624-3635
Mailing address
803 HIGHWAY 71 N, MENA, AR 71953-4367
(479) 394-6363
(479) 394-1046
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29795
BCBS
MO
05
—
620307207
—
MO
Enumeration date
03/09/2007
Last updated
01/19/2010
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