Organization
FAMILY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK B HOLTMAN (PARTNER)
(573) 564-2273
Entity
Organization
Contact information
Practice address
806 N STURGEON ST, MONTGOMERY CITY, MO 63361-1426
(573) 564-2273
(573) 564-5249
Mailing address
806 N STURGEON ST, MONTGOMERY CITY, MO 63361-1426
(573) 564-2273
(573) 564-5249
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
622645505
—
MO
Enumeration date
04/20/2007
Last updated
06/21/2013
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