Organization
ST. LOUIS JC VAMC
Active
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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