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Organization

HENDERSON DRUG STORE,LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID HENDERSON (OWNER)
(660) 338-2125
Entity
Organization

Contact information

Practice address
523 1ST ST, GLASGOW, MO 65254-1005
(660) 338-2125
(660) 338-2045
Mailing address
523 1ST ST, GLASGOW, MO 65254-1005
(660) 338-2125
(660) 338-2045

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
004501
MO
3336C0003X
Community/Retail Pharmacy
Primary
PS004501
MO
3336L0003X
Long Term Care Pharmacy
004501
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
600136006
MO
Enumeration date
10/03/2006
Last updated
02/16/2018
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