Organization
PHYSICIAN PARK INVESTMENT COMPANY
Active
Other names
Physicians Park Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
ROY WINTERS (PIC)
(573) 778-9238
Entity
Organization
Contact information
Practice address
225 PHYSICIANS PARK, STE 100A, POPLAR BLUFF, MO 63901-3956
(573) 778-9238
(573) 778-9582
Mailing address
225 PHYSICIANS PARK, STE 100A, POPLAR BLUFF, MO 63901-3956
(573) 778-9238
(573) 778-9582
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
2008022112
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2638142
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/14/2008
Last updated
09/13/2009
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