Semo Drug of Kennett

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

SEMO DRUG OF KENNETT

Practice address

1312 1St St
Kennett, MO 63857-2526

Phone

(573) 888-8880

Fax

(573) 888-3889

NPI assigned

Jun 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tyson Wallace, PHARM.D.

Title

Pharmacy Manager

Phone

(573) 888-8880

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mandy Denise Rebstock, PHARMD

  • Pharmacist
  • Piggott, AR
  • NPI 1346837960
  NPD

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053514356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 1ST ST",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638572526",
            "telephone_number": "573-888-8880",
            "fax_number": "573-888-3889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 1ST ST",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638572526",
            "telephone_number": "573-888-8880",
            "fax_number": "573-888-3889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEMO DRUG OF KENNETT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TYSON",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "573-888-8880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "858466006",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tina Marie Scott-Barnes, A.A.
• Donna J. Seal, LCSW
• Ethan Matthew Seats
• Marissa Jeree Sebastian, BS,BA,CC
• Jennifer R Sellman, D.O.
• Semo Drugs of Kennett Inc
• Semo Medical Equipment LLC
• Karl Erik Shanstrom, DO
• Wesley Kyle Shatley
• Heather Ann Shaver

• Pharmacy in Kennett, MO
• Providers in Kennett, MO by specialty
• Pharmacy in Missouri

• 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.