Organization
MAIN STREET MEDICAL PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE MCHARGUE NEAL PHARMD (OWNER, PIC)
(660) 663-7979
Entity
Organization
Contact information
Practice address
403 S MAIN ST, GALLATIN, MO 64640-1434
(660) 663-7979
(660) 663-2963
Mailing address
403 S MAIN ST, GALLATIN, MO 64640-1434
(660) 663-7979
(660) 663-2963
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019013549
MISSOURI STATE BOARD OF PHARMACY PERMIT
MO
01
—
2500053920
BNDD LICENSE
MO
Enumeration date
05/14/2019
Last updated
05/14/2019
Update your record
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