Organization
ST. LOUIS JC VAMC
Active
Other names
POPLAR BLUFF VAMC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN DENISE POTTER (NPI TEAM MEMBER)
(202) 382-2579
Entity
Organization
Contact information
Practice address
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
(573) 778-4245
(573) 778-4246
Mailing address
PO BOX 94462, CLEVELAND, OH 44101-4462
(913) 578-4409
Taxonomy
Speciality
Code
Description
License number
State
332100000X
Department of Veterans Affairs (VA) Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2616805
NCPDP#
MO
Enumeration date
05/03/2006
Last updated
10/23/2018
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