Organization
SAM'S PRESCRIPTION SHOP, INC.
Active
Other names
Sam's Health Mart Pharmacy # 1 (Long Term Care)
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN S TADRUS (OFFICER)
(660) 263-3309
Entity
Organization
Contact information
Practice address
300 N MORLEY ST, MOBERLY, MO 65270-2334
(660) 263-0909
(660) 263-2124
Mailing address
PO BOX 957, MOBERLY, MO 65270-0957
(660) 263-3309
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600061105
—
MO
05
—
620061101
—
MO
Enumeration date
09/16/2020
Last updated
08/24/2022
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