Organization
TOWN AND COUNTRY GROCERS OF FREDERICKTOWN MO INC
Active
Other names
COUNTRY MART
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBIE JOE HUFFORD (OWNER PRESIDENT)
(573) 783-5703
Entity
Organization
Contact information
Practice address
301 T J STEWART DR, PARK HILLS, MO 63601-2500
(573) 431-8537
(573) 431-2514
Mailing address
301 T J STEWART DR, PARK HILLS, MO 63601-2500
(573) 431-8537
(573) 431-2514
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2006035969
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2637265
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
12/06/2006
Last updated
02/10/2010
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