NPIMap

Organization Active NPI

St. John's Clinic Inc

Doing business as St. John's Pharmacy-Rolla

  • Pharmacist
  • Rolla, MO
National Provider Identifier
1043308497
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
2006027507 Issued in MO
Legal business name
ST. JOHN'S CLINIC INC
Doing business as
St. John's Pharmacy-Rolla
Practice address
1100 West 10TH Street
Suite 150
Rolla, MO 65401
Phone
(573) 426-4931
Fax
(573) 426-4932
NPI assigned
Oct 11, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Rob D Shockley, RPH
Title
Retail Pharmacy Coordinator
Phone
(417) 820-6624

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 183500000X 2006027507 MO Primary

Addresses

Primary practice location

1100 West 10TH Street
Suite 150
Rolla, MO 65401

Mailing address

1100 West 10TH Street
Suite 150
Rolla, MO 65401
Phone (573) 426-4931

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidMO

Other names 1

  • St. John's Pharmacy-Rolla Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Springfield Clinic Nucl55 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043308497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WEST 10TH STREET",
            "address_2": "SUITE 150",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "65401",
            "telephone_number": "573-426-4931",
            "fax_number": "573-426-4932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WEST 10TH STREET",
            "address_2": "SUITE 150",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "65401",
            "telephone_number": "573-426-4931",
            "fax_number": "573-426-4932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHOCKLEY",
        "authorized_official_first_name": "ROB",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "RETAIL PHARMACY COORDINATOR",
        "authorized_official_telephone_number": "417-820-6624",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2006027507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. John's Pharmacy-Rolla",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.