Organization
CRAIN MOXEY PHARM INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
ERNIE MOXEY RPH (OWNER PHARMACIST)
(573) 472-2622
Entity
Organization
Contact information
Practice address
613 S MAIN ST, SIKESTON, MO 63801-3041
(573) 472-2622
(573) 472-2623
Mailing address
613 S MAIN ST, SIKESTON, MO 63801-3041
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
003799
MO
332B00000X
Durable Medical Equipment & Medical Supplies
003799
MO
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2617578
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
601176902
—
MO
05
—
621176908
—
MO
05
—
851176909
—
MO
Enumeration date
11/15/2006
Last updated
03/07/2023
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