Organization
KB OSCEOLA DRUG LLC
Active
Other names
Evans Drugs
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY TIMMERMANN (MANAGER,AO)
(417) 876-3313
Entity
Organization
Contact information
Practice address
675 3RD ST, OSCEOLA, MO 64776-2934
(417) 646-2301
(417) 646-2456
Mailing address
675 3RD ST, OSCEOLA, MO 64776-2934
(417) 646-2301
(417) 646-2456
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2016042638
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2164581
PK
—
05
—
600038893
—
MO
Enumeration date
10/20/2016
Last updated
04/11/2020
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