Organization
HINES STREET PHARMACY LLC
Active
Other names
Hines Street Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN L MCCLANAHAN II RPH. (OWNER)
(417) 735-0055
Entity
Organization
Contact information
Practice address
1173 E HINES ST, REPUBLIC, MO 65738-1277
(417) 735-0055
(417) 732-1529
Mailing address
1173 E HINES ST, REPUBLIC, MO 65738-1277
(417) 735-0055
(417) 732-1529
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2012001548
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133471
PK
—
05
—
609551700
—
MO
Enumeration date
12/20/2011
Last updated
11/24/2020
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