Organization
NORTHWEST PHARMACY INC
Active
Other names
NORTHWEST PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK KLEINBECK RPH (PRESIDENT)
(573) 686-6211
Entity
Organization
Contact information
Practice address
2210 BARRON RD, POPLAR BLUFF, MO 63901-1908
(573) 686-6211
(573) 686-2219
Mailing address
2210 BARRON RD, POPLAR BLUFF, MO 63901-1908
(573) 686-6211
(573) 686-2219
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2004019998
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2627492
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600059729
—
MO
Enumeration date
12/04/2006
Last updated
11/16/2011
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