Organization
SAMS PRESCRIPTION SHOP INC
Active
Other names
Sam's Health Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN TADRUS (OWNER)
(660) 263-3309
Entity
Organization
Contact information
Practice address
530 EAST 24 HIGHWAY, MOBERLY, MO 65270-2500
(660) 263-6710
(660) 263-2269
Mailing address
PO BOX 957, (26-39586), MOBERLY, MO 65270-0957
(660) 263-3309
(660) 263-3514
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2010042682
MO
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2128544
PK
—
05
—
60020284
—
MO
Enumeration date
09/23/2010
Last updated
08/24/2022
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