Organization
SAM'S PRESCRIPTION SHOP, INC.
Active
Other names
Sam's Health Mart Pharmacy # 3 (Long Term Care)
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN TADRUS (OFFICER)
(660) 263-3309
Entity
Organization
Contact information
Practice address
300 N CHURCH ST, FAYETTE, MO 65248-1106
(660) 248-2275
(660) 248-2858
Mailing address
PO BOX 957, MOBERLY, MO 65270-0957
(660) 263-3309
(660) 263-3514
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
004390
MO
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2162344
PK
—
05
—
600061113
—
MO
Enumeration date
08/02/2016
Last updated
08/24/2022
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