Organization
BUFFALO PROFESSIONAL PHARMACY INC
Active
Other names
CORNER DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
AL NYBERG (PRESIDENT AND CHIEF RPH)
(417) 345-6500
Entity
Organization
Contact information
Practice address
308 W DALLAS ST, BUFFALO, MO 65622-7635
(417) 345-6500
(417) 345-6565
Mailing address
PO BOX 710, BUFFALO, MO 65622-0710
(417) 345-6500
(417) 345-6565
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
005240
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2051305
PK
—
05
—
602895104
—
MO
Enumeration date
09/14/2006
Last updated
09/19/2025
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