Organization
MAIN STREET PHARMACY LLC
Active
Other names
MAIN STREET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TERA JOHNSON (MANAGER)
(573) 649-9229
Entity
Organization
Contact information
Practice address
117 E MAIN ST, EAST PRAIRIE, MO 63845-1136
(573) 649-9229
(573) 649-9230
Mailing address
117 E MAIN ST, EAST PRAIRIE, MO 63845-1136
(573) 649-9229
(573) 649-9230
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2013000674
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2048743
PK
—
05
—
605420405
—
MO
Enumeration date
02/26/2007
Last updated
02/09/2015
Update your record
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