Organization
ELLIOTT PHARMACY INC
Active
Other names
Elliott HealthMart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY NELSON (OWNER PHARMACIST)
(660) 665-9871
Entity
Organization
Contact information
Practice address
2120 N BALTIMORE ST, KIRKSVILLE, MO 63501-5109
(660) 665-9871
(660) 665-4332
Mailing address
PO BOX 72, KIRKSVILLE, MO 63501-0072
(660) 665-9871
(660) 665-4332
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
005972
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2608187
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600398804
—
MO
Enumeration date
07/30/2006
Last updated
04/30/2012
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