Active NPI
Medkin Pharmacy LLC
- Pharmacy
- Sullivan, MO
National Provider Identifier
1003849316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 5100
- Legal business name
- MEDKIN PHARMACY LLC
- Doing business as
- Medicine Cabinet Pharmacy
- Practice address
- 105 Progress Pkwy
Sullivan, MO 63080-2359 - Phone
- (573) 860-3600
- Fax
- (573) 860-2636
- NPI assigned
- Jul 9, 2006
- Organization subpart
- Yes
- Parent organization
- MEDKIN PHARMACY LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. John Wayne Hewkin, RPH.
- Title
- Member/Owner/Pharmacist
- Phone
- (573) 308-5033
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 5100 | MO | Primary |
| Community/Retail Pharmacy | 3336C0003X | 2003001706 | MO |
Addresses
Primary practice location
105 Progress Pkwy
Sullivan, MO 63080-2359
Mailing address
105 Progress Pkwy
Medicine Cabinet Pharmacy
Sullivan, MO 63080-2359
Phone (573) 860-3600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6060000701 | Medicaid | MO | |
| 626000707 | Medicaid | MO | |
| 5100 | Other | MO | MO BOARD OF PHARMA |
Other names 1
- Medicine Cabinet Pharmacy
National Provider Directory
National Provider Directory- Part of
- Medkin Pharmacy LLC
Locations
105 Progress Pkwy
Sullivan, MO 63080
Phone (573) 860-3600
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1258329600000",
"number": "1003849316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 PROGRESS PKWY",
"address_2": "MEDICINE CABINET PHARMACY",
"city": "SULLIVAN",
"state": "MO",
"postal_code": "630802359",
"telephone_number": "573-860-3600",
"fax_number": "573-860-2636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 PROGRESS PKWY",
"city": "SULLIVAN",
"state": "MO",
"postal_code": "630802359",
"telephone_number": "573-860-3600",
"fax_number": "573-860-2636"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDKIN PHARMACY LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MEDKIN PHARMACY LLC",
"enumeration_date": "2006-07-09",
"last_updated": "2009-11-16",
"status": "A",
"authorized_official_last_name": "HEWKIN",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "WAYNE",
"authorized_official_title_or_position": "MEMBER/OWNER/PHARMACIST",
"authorized_official_telephone_number": "573-308-5033",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "RPH."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MO",
"license": "5100",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MO",
"license": "2003001706",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6060000701",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "626000707",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MO BOARD OF PHARMA",
"identifier": "5100",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Medicine Cabinet Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sullivan, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.