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Organization

CARROLL CNTY MEM HOSP PHARMACY INC

Active
Other names
CARROLL COUNTY MEM HOSP PHCY
Organization subpart
No

Provider details

NPI number
Authorized official
JERRY DOVER (CEO)
(660) 542-1695
Entity
Organization

Contact information

Practice address
1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948
(660) 542-1695
(660) 542-0363
Mailing address
1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948

Taxonomy

Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
21044
MO
3336I0012X
Institutional Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0909150
MO
01
2623266
OTHER ID NUMBER-COMMERCIAL NUMBER
Enumeration date
08/22/2006
Last updated
08/22/2020
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