Organization
SHELL KNOB PHARMACY LLC
Active
Other names
PLAZA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CONG DANG (OWNER)
(417) 766-6990
Entity
Organization
Contact information
Practice address
24832 STATE HIGHWAY 39, SHELL KNOB, MO 65747-8417
(417) 858-2200
(417) 858-2216
Mailing address
PO BOX 419, SHELL KNOB, MO 65747-0419
(417) 858-2200
(417) 858-2216
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2016013824
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159951
PK
—
05
—
602912701
—
MO
Enumeration date
07/25/2006
Last updated
11/18/2022
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