Organization
STATE OF MISSOURI
Active
Other names
SOUTHEAST MISSOURI MENTAL HEALTH CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-4055
Entity
Organization
Contact information
Practice address
1010 W COLUMBIA ST, FARMINGTON, MO 63640-2902
(573) 218-6759
(573) 218-6762
Mailing address
1010 W COLUMBIA ST, FARMINGTON, MO 63640-2902
(573) 218-6759
(573) 218-6762
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
001820
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050490200
—
MO
01
—
2048857
PK
—
Enumeration date
02/05/2007
Last updated
08/28/2020
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