Organization
PHYSICIAN PARK INVESTMENT COMPANY
Active
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
Update your record
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