Organization
HERMITAGE PROFESSIONAL ENTERPRISES INC
Active
Other names
HERMITAGE PROFESSIONAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AL NYBERG (PRESIDENT)
(417) 745-2136
Entity
Organization
Contact information
Practice address
23649 DALLAS ST, HERMITAGE, MO 65668-9231
(417) 745-2136
(417) 745-2130
Mailing address
PO BOX 370, HERMITAGE, MO 65668
(417) 745-2136
(417) 745-2130
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
004831
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050737
PK
—
05
—
602206906
—
MO
Enumeration date
09/26/2006
Last updated
09/19/2025
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