Organization
FICOM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACKENZIE HAHN (NCPDP COORDINATOR)
(888) 590-0808
Entity
Organization
Contact information
Practice address
1308 NORTH GLENSTONE AVENUE, SPRINGFIELD, MO 65802
(888) 590-0808
(866) 740-4689
Mailing address
200 RITTENHOUSE CIRCLE, EAST BUILDING STE 5, BRISTOL, PA 19007
(888) 590-0808
(866) 740-4689
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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